Health the basics 11e global edition donatelle 1

Health The Basics For these Global Editions, the editorial team at Pearson has collaborated with educators across the world to address a wide range of subjects and requirements, equipping students with the best possible learning tools This Global Edition preserves the cutting-edge approach and pedagogy of the original, but also features alterations, customization and adaptation from the North American version Global edition Global edition Global edition H   ealth T   he Basics eleventh edition eleventh edition Donatelle This is a special edition of an established title widely used by colleges and universities throughout the world Pearson published this exclusive edition for the benefit of students outside the United States and Canada If you purchased this book within the United States or Canada you should be aware that it has been imported without the approval of the Publisher or Author Rebecca J Donatelle Pearson Global Edition DONATELLE_1292057769_mech.indd 23/04/14 2:43 PM   11th Edition Health The Basics Global Edition Rebecca J Donatelle Oregon State University Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montréal Toronto Delhi Mexico City São Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Executive Editor: Sandra Lindelof Associate Editor: Erin Schnair Editorial Manager: Susan Malloy Development Editors: Marilyn Freedman, Nic Albert, and Erin Strathmann Production Project Managers: Megan Power and Michael Penne Editorial Assistant: Tu-Anh Dang-Tran Assistant Editor: Briana Verdugo Head of Learning Asset Acquisition, Global Edition: Laura Dent Senior Acquisitions Editor, Global Edition: Priyanka Ahuja Project Editor, Global Edition: Laura Thompson Senior Manufacturing Controller, Production, Global Edition: Trudy Kimber Content Producer: Julia Akpan Managing Editor: Mike Early Assistant Managing Editor: Nancy Tabor Production Management: Thistle Hill Publishing Services Compositor: Vinolia Benedict Fernando Illustrator: Precision Graphics Senior Photo Editor: Travis Amos Manager of Image Resources: Maya Melenchuk Senior Manufacturing Buyer: Stacey Weinberger Executive Marketing Manager: Neena Bali Cover Photo Credit: Wavebreakmedia/Shutterstock Credits and acknowledgments borrowed from other sources and reproduced, with permission, in this textbook appear on the appropriate page within the text and on p C-1 Pearson Education Limited Edinburgh Gate Harlow Essex CM20 2JE England and Associated Companies throughout the world Visit us on the World Wide Web at: www.pearsonglobaleditions.com © Pearson Education Limited 2015 The right of Rebecca J Donatelle to be identified as author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988 Authorised adaptation from the United States edition, entitled Health: The Basics, Eleventh Edition, ISBN 978-0-321-91042-4 by Rebecca J Donatelle, published by Pearson Education © 2015 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, ­electronic, mechanical, photocopying, recording or otherwise, without either the prior written permission of the publisher or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS All trademarks used herein are the property of their respective owners The use of any trademark in this text does not vest in the a­ uthor or publisher any trademark ownership rights in such trademarks, nor does the use of such trademarks imply any affiliation with or endorsement of this book by such owners Many of the designations by manufacturers and sellers to distinguish their products are claimed as trademarks Where those d ­ esignations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps ISBN-13: 978-1-292-05776-7 (Print) ISBN-13: 978-1-292-05834-4 (PDF) ISBN-10: 1-292-05776-9 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library 10 15 14 13 12 11 Typeset by Cenveo Publisher Services/Nesbitt Graphics A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Brief Contents 10 Reaching and Maintaining a Healthy Weight  Part One Finding the Right Balance   FOCUS On Enhancing Your Body Image  Accessing Your Health  25 FOCUS On Improving Your Financial Health  50   Promoting and Preserving Your Psychological Health 61 FOCUS On Cultivating Your Spiritual Health  84   Managing Stress and Coping with Life’s Challenges 95 FOCUS On Improving Your Sleep      Preventing Violence and Injury  134 Building Healthy Relationships and Understanding Sexuality  158 Considering Your Reproductive Choices  190 Part Three Avoiding Risks from Harmful Habits     353 Part Five Preventing and Fighting Disease 12 Reducing Your Risk of Cardiovascular  Disease and Cancer  378 FOCUS On Minimizing Your Risk for Diabetes  410 13 Protecting against Infectious Diseases and Sexually Transmitted Infections  420 Creating Healthy and Caring Relationships 342 122 Part Two   11 Improving Your Personal Fitness  315 Recognizing and Avoiding Addiction  and Drug Abuse  222 Drinking Alcohol Responsibly and Ending Tobacco Use  251 FOCUS On Reducing Risks and Coping with Chronic Diseases and Conditions  448 Part Six Facing Life’s Challenges 14 Preparing for Aging, Death, and Dying  457 15 Promoting Environmental Health  477 16 Making Smart Health Care Choices  498 FOCUS On Understanding Complementary and Alternative Medicine  514 Answers to Chapter Review Questions   A-1 References   R-1 Part Four Building Healthy Lifestyles   Eating for a Healthier You  283 Photo Credits   C-1 Index   I-1 A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Contents Preface  17 Acknowledgments  22 Part One: Finding the Right Balance Accessing Your Health  25 Why Health, Why Now?  26 Choosing Health Now Has Immediate Benefits  26 Choosing Health Now Leads to Many Long-Term Rewards 26 Choosing Health Now Benefits Others  28 What Is Health?  28 Models of Health  28 Wellness and the Dimensions of Health  30 What Influences Health?  31 Individual Behavior  32 Biology and Genetics  32 Social Factors  33 Access to Quality Health Services  35 Policymaking 35 Health Disparities  35 How Can You Improve Your Health Behaviors?  35 Models of Behavior Change  35 Step One: Increase Your Awareness  38 Step Two: Contemplate Change  38 Step Three: Prepare for Change  41 Step Four: Take Action to Change  43 Let’s Get Started!  44 Protect Against Fraud and Identity Theft  56 Credit Card Theft  57 Debit Card Theft  57 Medical Account Theft  57 Protecting Personal Information and Avoiding Scams  57 Cleaning Up Identity Theft Messes  58 Assessyourself  Budgeting for College Students  59 Promoting and Preserving Your Psychological Health  61 What Is Psychological Health?  62 Mental Health  63 Emotional Health  63 Social Health  64 Spiritual Health  65 Factors That Influence Psychological Health  65 Family 65 Support System  65 Community 66 Self-Efficacy and Self-Esteem  66 Personality 66 Life Span and Maturity  67 Assessyourself  How Healthy Are You?  45 Summary  48 FOCUS On Improving Your Financial Health  50 The Links between Health and Wealth  50 Making a Budget  51 Set Goals  52 Track Expenses  52 Track Income  52 Making the Budget Numbers Add Up  52 Debt and Credit Basics  53 Types of Student Aid  54 Credit Cards  54 A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Strategies to Enhance Psychological Health  68 Managing Stress and Coping with When Psychological Health Deteriorates  69 Mental Health Threats to College Students  70 What Is Stress?  96 The Mind–Body Connection  68 Mood Disorders  70 Major Depression  70 Dysthymic Disorder  71 Bipolar Disorder  72 Seasonal Affective Disorder (SAD)  72 What Causes Mood Disorders?  72 Anxiety Disorders  72 Generalized Anxiety Disorder (GAD)  73 Panic Disorders  73 Phobic Disorders  73 Obsessive-Compulsive Disorder (OCD)  73 Post-Traumatic Stress Disorder (PTSD)  74 What Causes Anxiety Disorders?  74 Personality Disorders  74 Schizophrenia  75 Suicide: Giving Up on Life  75 Warning Signs of Suicide  75 Preventing Suicide  76 Seeking Professional Help for Psychological Problems  77 Mental Illness Stigma  77 Getting Evaluated for Treatment  78 Mental Health Professionals  78 What to Expect in Therapy  80 Pharmacological Treatment  80 Assessyourself  Staying Psychologically Healthy: Test Your Coping Skills  81 Summary  82 FOCUS On Cultivating Your Spiritual Health  84 What Is Spirituality?  85 Religion and Spirituality Are Distinct Concepts  86 Spirituality Integrates Three Facets  86 Spiritual Intelligence Is an Inner Wisdom  87 The Benefits of Spiritual Health  87 Physical Benefits  87 Psychological Benefits  88 Benefits from Lowered Stress  88 What Can You Do to Focus on Your Spiritual Health?  89 Train Your Body  89 Expand Your Mind  89 Tune in to Yourself and Your Surroundings  90 Reach Out to Others  93 Assessyourself  What’s Your Spiritual IQ?  94 Life’s Challenges  95 Your Body’s Stress Response  97 The General Adaptation Syndrome  97 Lifetime Effects of Stress  99 Physical Effects of Stress  100 Intellectual Effects of Stress  101 Psychological Effects of Stress  101 What Causes Stress?  102 Psychosocial Stressors  102 Internal Stressors  105 Are Internal Stressors Inescapable?  106 Managing Stress in College  107 Practicing Mental Work to Reduce Stress  108 Developing a Support Network  109 Cultivating Your Spiritual Side  109 Managing Emotional Responses  109 Taking Physical Action  110 Managing Your Time  111 Consider Downshifting  112 Relaxation Techniques for Stress Management  113 Assessyourself  How Stressed Are You?  117 Summary  120 FOCUS On Improving Your Sleep  122 Sleepless in America  123 Wired and Tired: Technology’s Toll on Our Sleep  123 Sleepy Workers  124 Why Do You Need to Sleep? 124 Sleep Maintains Your Physical Health  124 Sleep Affects Your Ability to Function  125 Sleep Promotes Your Psychosocial Health  125 What Goes on When You Sleep?  126 Non-REM Sleep Is Restorative  126 REM Sleep Is Energizing  127 How Much Sleep Do You Need?  127 Sleep Need Includes Baseline plus Debt  127 Do Naps Count?  128 How to Get a Good Night’s Sleep  128 Do’s and Don’ts for Restful Sleep  128 What If You Still Can’t Sleep?  129 Insomnia 131 Sleep Apnea  131 Restless Legs Syndrome  132 Narcolepsy 132 Assessyourself  Are You Sleeping Well?  133 contents   |   A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Preventing Violence and Injury  134 Violence in the United States  135 Violence on U.S Campuses  135 Factors Contributing to Violence  136 What Makes Some People Prone to Violence?  137 How Much Impact Do the Media Have?  138 Intentional Injuries  139 Homicide 139 Hate and Bias-Motivated Crimes  139 Gang Violence  141 Terrorism 141 Domestic Violence  141 Sexual Victimization  143 Sexual Assault and Rape  143 Child Sexual Abuse  145 Sexual Harassment  145 Stalking 146 Social Contributors to Sexual Violence 146 Minimize Your Risk of Becoming a Victim of Violence  147 Self-Defense against Personal Assault and Rape  147 What to Do if Rape Occurs  148 Campuswide Responses to Violence  149 Prevention and Early Response Efforts  149 Community Strategies for Preventing Violence  150 Unintentional Injuries  150 Vehicle Safety  151 Cycling Safety  152 Assessyourself  Are You at Risk for Violence or Injury? 154 Summary  156 Creating Healthy and Caring   Relationships Part Two: Building Healthy Relationships and   Understanding Sexuality  158 Intimate Relationships  159 Relating to Yourself  160 Family Relationships  160 Friendships 161 Romantic Relationships  161 Choosing a Romantic Partner  162 Communicating: A Key to Good Relationships  162 Learning Appropriate Self-Disclosure  163 Becoming a Better Listener  165 Using Nonverbal Communication  165 Managing Conflict through Communication  167 Committed Relationships  167 Marriage 167 Cohabitation 168 Gay and Lesbian Marriage/ Partnerships 169 Staying Single  169 Choosing Whether to Have Children  170 When Relationships Falter  172 Confronting Couples Issues 172 When and Why Relationships End  173 Coping with Failed Relationships 174 Your Sexual Identity: More Than Biology  175 Sexual Orientation  176 Sexual Anatomy and Physiology  177 Female Sexual Anatomy and Physiology  177 Male Sexual Anatomy and Physiology  180 Human Sexual Response  181 Expressing Your Sexuality  182 Sexual Behavior: What Is “Normal”?  182 Options for Sexual Expression  182 Responsible and Satisfying Sexual Behavior  184 Variant Sexual Behavior  185 Sexual Dysfunction  185 Drugs and Sex  186 Assessyourself  How Well Do You Communicate?  187 Summary  188 Considering Your Reproductive Choices  190 Basic Principles of Birth Control  191 Barrier Methods  192 Male Condom  192 Female Condom  194 Jellies, Creams, Foams, Suppositories, and Film  195 Diaphragm with Spermicidal Jelly or Cream  196 Cervical Cap with Spermicidal Jelly or Cream  196 Contraceptive Sponge  197 Hormonal Methods  197 Oral Contraceptives  197 Progestin-Only Pills  199 Contraceptive Skin Patch  199 Vaginal Contraceptive Ring  200 Contraceptive Injections  200 Contraceptive Implants  201   |   contents A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Intrauterine Contraceptives  201 ParaGard and Mirena IUDs  201 Emergency Contraception  202 Behavioral Methods  202 Withdrawal 203 Abstinence and “Outercourse”  203 Fertility Awareness Methods  203 Surgical Methods  204 Female Sterilization  204 Male Sterilization  205 Choosing a Method of Contraception  205 Abortion  206 The Debate over Abortion  207 Emotional Aspects of Abortion  207 Methods of Abortion  207 Looking Ahead to Pregnancy and Parenthood  208 Emotional Health  209 Financial Evaluation  209 Physical Health: Paternal Health  209 Physical Health: Maternal Health  209 Pregnancy  210 The Process of Pregnancy  210 Prenatal Care  212 Childbirth  214 Labor and Delivery  214 Complications of Pregnancy and Childbirth  215 The Postpartum Period  216 Infertility  216 Causes in Women  217 Causes in Men  217 Infertility Treatments  217 Gestational Surrogacy  218 Adoption 218 Assessyourself Are You Comfortable with Your Contraception? 219 Summary  220 Part Three: Avoiding Risks from  Harmful Habits Recognizing and Avoiding Addiction and Drug Abuse  222 What Is Addiction?  223 The Process of Addiction  223 Habit versus Addiction  224 Addiction Affects Family and Friends  224 Addictive Behaviors  225 Disordered Gambling  225 Compulsive Buying Disorder  226 Exercise Addiction  226 Technology Addictions  227 What Is a Drug?  228 How Drugs Affect the Brain  228 Types of Drugs  229 Routes of Drug Administration  229 Drug Interactions  230 Drug Misuse and Abuse  230 Abuse of Over-the-Counter Drugs  230 Prescription Drug Abuse  231 College Students and Prescription Drug Abuse  231 Illicit Drugs  232 Illicit Drug Use on Campus  232 Common Drugs of Abuse  233 Stimulants 233 Marijuana and Other Cannabinoids  237 Narcotics and Depressants  240 Hallucinogens 242 Inhalants 244 Anabolic Steroids  244 Treatment and Recovery  245 Treatment Approaches  245 Drug Treatment and Recovery for College Students 246 Addressing Drug Misuse and Abuse in the United States  247 Harm Reduction Strategies  247 Assessyourself Do You Have a Problem with Drugs? 248 Summary  249 Drinking Alcohol Responsibly and Ending Tobacco Use  251 Alcohol: An Overview  252 Alcohol and College Students  252 High-Risk Drinking and College Students  253 Efforts to Reduce Student Drinking  254 contents   |   A01_DONA7767_11_GE_FM.indd 04/06/14 6:54 PM Alcohol in the Body  255 The Chemistry and Potency of Alcohol  255 Absorption and Metabolism  255 Blood Alcohol Concentration  257 Alcohol and Your Health  259 Immediate and Short-Term Effects of Alcohol  259 Long-Term Effects of Alcohol  261 Alcohol and Pregnancy  262 Drinking and Driving  262 Abuse and Dependence  263 Identifying an Alcoholic  263 The Causes of Alcohol Abuse and Alcoholism  263 Women and Alcoholism  264 Alcohol and Prescription Drug Abuse  265 Costs to Society  265 Treating Alcoholism  265 Treatment Programs  266 Relapse 266 Food Safety: A Growing Concern  306 Foodborne Illnesses  306 Avoiding Risks in the Home  308 Food Sensitivities  308 Genetically Modified Food Crops  309 Habits? 311 Summary  313 Tobacco and Its Effects  268 Nicotine 268 Tar and Carbon Monoxide  269 Tobacco Addiction  270 Tobacco Products  270 10 Reaching and Maintaining a Healthy Health Hazards of Tobacco Products  271 Cancer 272 Cardiovascular Disease  272 Respiratory Disorders  273 Sexual Dysfunction and Fertility Problems  273 Unique Risks for Women  273 Other Health Effects  274 Environmental Tobacco Smoke  274 Risks from Environmental Tobacco Smoke  274 Tobacco Use and Prevention Policies  274 Quitting  275 Breaking the Nicotine Addiction  275 Benefits of Quitting  277 Assessyourself  Alcohol and Tobacco: Are Your Habits Placing You at Risk?  279 Summary  281 Building Healthy Lifestyles Eating for a Healthier You  How Can I Eat More Healthfully?  299 Dietary Guidelines for Americans, 2010  299 MyPlate Food Guidance System  300 Choose Foods Wisely—Read the Labels  301 Vegetarianism: A Healthy Diet?  303 Supplements: Research on the Daily Dose  303 Choosing Organic or Locally Grown Foods  304 Eating Well in College  305 Assessyourself  How Healthy Are Your Eating Tobacco Use in the United States  266 Tobacco and Social Issues  266 College Students and Tobacco Use  267 Part Four: Water: A Crucial Nutrient  285 Proteins 286 Carbohydrates 287 Fats 289 Vitamins 292 Minerals 296 283 Essential Nutrients for Health  284 Recommended Intakes for Nutrients  284 Calories 285 Weight  315 Factors Contributing to Overweight and Obesity  317 Genetic and Physiological Factors  318 Environmental Factors  321 Psychosocial and Socioeconomic Factors  322 Lack of Physical Activity  322 Assessing Body Weight and Body Composition  324 Body Mass Index (BMI)  324 Waist Circumference and Ratio Measurements 326 Measures of Body Fat  326 Managing Your Weight  327 Improving Your Eating Habits 328 Understanding Calories and ­Energy Balance  329 Including Exercise  331 Some Perspective on Weight ­Control Efforts  332 Considering Drastic Weight-Loss Measures 332 Trying to Gain Weight  336 Assessyourself  Are You Ready to Jump Start Your Weight Loss?  337 Summary  340   |   contents A01_DONA7767_11_GE_FM.indd 04/06/14 6:55 PM FOCUS On Enhancing Your Body Image  342 What Is Body Image?  343 Many Factors Influence Body Image  343 How Can I Build a More Positive Body Image?  345 Some People Develop Body Image Disorders  345 What Is Disordered Eating?  346 Some People Develop Eating Disorders  347 How Can You Help Someone with Disordered Eating? 350 Can Exercise Be Unhealthy?  350 Some People Develop Exercise Disorders  351 Assessyourself  Are Your Efforts to Be Thin Sensible— The FITT Principle for Cardiorespiratory Fitness  363 The FITT Principle for Muscular Strength and Endurance 365 The FITT Principle for Flexibility  367 Implementing Your Fitness Program  367 Develop a Progressive Plan  367 Design Your Exercise Session  367 Activities That Develop Multiple Components of Fitness 369 Preventing and Treating Fitness-Related Injuries  370 Treating Injuries  371 Preventing Injuries  372 Assessyourself  How Physically Fit Are You?  374 Summary  376 Or Spinning Out of Control?  352 Part Five: 11 Improving Your Personal Fitness  353 Physical Activity for Health  354 Reduced Risk of Cardiovascular Diseases  355 Reduced Risk of Metabolic Syndrome and Type Diabetes 356 Reduced Cancer Risk  356 Improved Bone Mass and Reduced Risk of Osteoporosis 357 Improved Weight Management 357 Improved Immunity  357 Improved Mental Health and Stress Management 358 Longer Life Span  358 Physical Activity for Fitness and Performance  358 Health-Related Components of Physical Fitness  358 Skill-Related Components of Physical Fitness 359 Getting Motivated and Committing to Your Physical Fitness  360 What If I Have Been Inactive for a While? 360 Overcoming Common Obstacles to Physical Activity 360 Incorporating Physical Activity in Your Life  361 Creating Your Own Fitness Program  361 Principles of Fitness Training: FITT  363   Preventing and Fighting Disease 12  Reducing Your Risk of Cardiovascular Disease and Cancer  378 Cardiovascular Disease: An Overview  379 Understanding the Cardiovascular System  380 The Heart: A Mighty Machine  380 Cardiovascular Disease  381 Hypertension 382 Atherosclerosis 382 Peripheral Artery Disease (PAD)  383 Coronary Heart Disease (CHD)  383 Angina Pectoris  384 Arrhythmias 384 Heart Failure  384 Stroke 385 Reducing Your Risks  386 Metabolic Syndrome: Quick Risk Profile 386 Modifiable Risks  386 Nonmodifiable Risks  388 Other Risk Factors Being Studied 389 Weapons against Cardiovascular Disease  390 Techniques for Diagnosing Cardiovascular Disease  391 Bypass Surgery, Angioplasty, and Stents  391 Aspirin and Other Drug Therapies  391 Cancer: An Overview  391 What Is Cancer?  392 What Causes Cancer?  393 Lifestyle Risks  394 Genetic and Physiological Risks  394 Alcohol and Cancer Risks  395 Inflammation and Cancer Risks  395 Occupational and Environmental Risks  395 contents   |   A01_DONA7767_11_GE_FM.indd 04/06/14 6:55 PM www.freebookslides.com 76% Hear It! Podcasts of college students say they are “searching for meaning and purpose in life.” important focus of her daily life, bringing her greater awareness and serenity If you’re feeling as if you could use a little more of these qualities in your own life, read on: This chapter will help you explore ways to sharpen your spiritual focus What Is Spirituality? From one day to the next, many of us attempt to satisfy our needs for belonging and self-esteem by acquiring material possessions But at some point we come to realize that new gadgets, clothes, or concert tickets don’t necessarily make Want a study podcast for this chapter? Download the podcast Psychosocial Health: Being Mentally, Emotionally, and Spiritually Well in the Study Area of us happy or improve our sense of selfworth That’s when many of us begin to contemplate another side of ourselves: our spirituality But what is spirituality? It isn’t easy to define Although part of the universal human experience, it’s highly personal and involves feelings and senses that are often intangible As such, it tends to defy the boundaries that strict definitions would impose Let’s begin by exploring its root, spirit, which in many cultures refers to breath, or the force that animates life When you’re “inspired,” your energy flows You’re not held back by doubts about the purpose or meaning of your work and life Indeed, many definitions of spirituality incorporate this sense of transcendence For example, the National A quiet meadow can be an ideal spot for ­contemplation and spiritual renewal compared to their peers, 35.9 percent of incoming freshman students rated themselves above average in spirituality, 51.5 percent in emotional health, and 79.6 percent in being able to work with a diverse population.2 Also, researchers found that 87.4 percent reported volunteering in the past year and 57.2 percent reported participating in community service as part of a class Lastly, 73 percent of students reported high levels of being tolerant of diverse beliefs.3 Spiritual health is one of six key dimensions of health (see Figure 1.4 on page 31) Lia’s sense of wonder and respect for the natural world and her gratitude for the good things in her life suggest that spiritual health is an How many college students focus on their spiritual health? Spiritual and ethical concerns are important to a majority of American college students One of the ways college students express their spirituality is by working to reduce suffering in the world; many contribute their time and skills to volunteer organizations, as these students are doing by working to build homes for Habitat for Humanity FOCUS ON  |   CULTIVATING YOUR SPIRITUAL HEALTH  |   85 M04_DONA7767_11_GE_C02A.indd 85 31/05/14 10:08 AM www.freebookslides.com spirituality An individual’s sense of peace, purpose, and connection to others and beliefs about the meaning of life religion A system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent Cancer Institute defines spirituality as an individual’s sense of peace, purpose, and connection to others, and beliefs about the meaning of life.4 Similarly, Harold G Koenig, MD, one of the foremost researchers of spirituality and health, defines spirituality as the personal quest for understanding answers to ultimate questions about life, about meaning, and about our relationship with the sacred or transcendent.5 The sacred or transcendent could be a higher power or it could relate to our relationship with nature or forces we cannot explain Religion and Spirituality Are Distinct Concepts Spirituality may or may not lead to participation in organized religion; that is, a system of beliefs, practices, T a b l e Characteristics Distinguishing Religion and Spirituality Religion Spirituality Community focused Individualistic Observable, measurable, objective Less measurable, more subjective Formal, orthodox, organized Less formal, less orthodox, less systematic Behavior oriented, outward practices Emotionally oriented, inwardly directed Authoritarian in terms of behaviors Not authoritarian, little accountability Doctrine separating good from evil Unifying, not doctrine oriented Source: National Center for Complementary and Alternative Medicine (NCCAM), “Prayer and Spirituality in Health: Ancient Practices, Modern Science,” CAM at the NIH 12, no (2005): 1–4 rituals, and symbols designed to facilitate closeness to the sacred or transcendent.6 In other words, although spirituality and religion share some common elements, they are not the same thing Most Americans consider spirituality to be important in their lives, but not necessarily in the form of religion: A recent national survey revealed that 73 percent of Americans 30 years and older believe in God, but not all of these respondents identified themselves as being affiliated with a particular religion.7 Thus, it’s clear that religion does not have to be part of a spiritual person’s life Table identifies some characteristics that can help you distinguish between religion and spirituality Another finding of the same survey was that 74 percent of Americans affiliated with a religious tradition agreed that other religions are also valid.8 Perhaps this is because all major religions express a belief in a unifying spiritual concept, a oneness with a greater power It seems that a majority of Americans recognize and respect this underlying unity of spiritual ideas, expressed in different religious and spiritual practices Spirituality Integrates Three Facets Is spirituality the same as religion? Spirituality and religion are not the same Many people find that religious practices, such as attending services or making offerings—such as the small lamp this Hindu woman is placing in the sacred Ganges River—help them to focus on their spirituality However, religion does not have to be part of a spiritual person’s life Brian Luke Seaward, a professor at the University of Northern Colorado and author of several books on spirituality and mind–body healing, identifies three facets of human existence that together constitute the core of human spirituality: relationships, values, and purpose in life (Figure 1, page 87).9 Questions arising in these three domains prompt many of us to look for spiritual answers At the same time, spiritual well-being is characterized by healthy relationships, strong personal values, and a sense that we have a meaningful purpose in life Relationships Have you ever wondered if someone you were attracted to is really right for you? Or, conversely, 86  |   Part one  |   Finding the Right Balance M04_DONA7767_11_GE_C02A.indd 86 31/05/14 10:08 AM www.freebookslides.com Values by which we conduct our lives It’s what we stand for When we attempt to clarify our values, and then to live according to those values, we’re engaging in spiritual work Spiritual health is characterized by a strong personal value system R s hip s n tio ela Pu rp o Meaningful Purpose in Life What career you plan to pursue after you graduate? Do you hope nL to marry? Do you plan to ife have or adopt children? What things will make you happy and feel “complete”? How these choices reflect what you hold as your purpose in life? At the end of your days, what things would you want people to say about how you’ve lived your life and what your life Video Tutor: Facets of has meant to others? ConSpirituality templating these questions fosters spiritual growth People who are spiritually healthy are able to articulate their purpose, and to make choices that manifest that purpose In thinking about your own purpose, avoid the temptation to get too ambitious, as in, “I’m here to eradicate world hunger!” Instead, try to articulate just what you see as your unique contribution to the world—something you can actually do, starting now se i Figure Three Facets of Spirituality Most of us are prompted to explore our spirituality because of questions relating to our relationships, values, and purpose in life At the same time, these three facets together constitute spiritual well-being if you should break off a long-term relationship? Have you ever wished you had more friends, or that you were a better friend to yourself? Have you ever tried to make a connection with some sort of Presence or Higher Self? For many people, such questions and yearnings are natural triggers for spiritual growth: As we contemplate whom we should choose as a life partner or how to mend a quarrel with a friend, we begin to foster our own inner wisdom At the same time, healthy relationships are a sign of spiritual wellbeing When we treat ourselves and others with respect, honesty, integrity, and love, we are manifesting our spiritual health Values Our personal values are our principles—not only the things we say we care about, but also the things that cause us to behave the way we For instance, if you value honesty, then you are not likely to call in sick for work when you intend to spend the day at the beach In other words, our value system is the set of fundamental rules Spiritual Intelligence Is an Inner Wisdom Our relationships, values, and sense of purpose together contribute to our overall spiritual intelligence (SI) This term was introduced by physicist and philosopher Danah Zohar, who defined it as “an ability to access higher meanings, values, abiding purposes and unconscious aspects of the self.”10 Zohar includes qualities such as the ability to think outside the box, humility, and an access to energies that come from a source beyond the ego in her definition of spiritual intelligence, explaining that SI helps us use meanings, values, and purposes to live a richer and more creative life Since Zohar’s introduction of SI, dozens of clerics, psychologists, and even business consultants have expanded on the definition For example, Rabbi Yaacov Kravitz of the Center for Spiritual Intelligence explains that SI helps us find a moral and ethical path to help guide us through life SI also helps us in the search for meaning and purpose in life Would you like to find out your own spiritual IQ? See the Assess Yourself box on page 94 The Benefits of Spiritual Health The importance of the mind–body connection and spiritual health to overall health and wellness has been documented by a broad range of largescale surveys.11 Physical Benefits The emerging science of mind–body medicine is a research focus of the National Center for Complementary and Alternative Medicine (NCCAM) and an important objective in NCCAM’s 2011– 2015 Strategic Plan One area under study is the association between spiritual health and general health The NCCAM cites evidence that spirituality can have a positive influence on health and suggests that the connection may be due to improved immune function, cardiovascular function, other physiological changes, or a combination of all three More and more studies are showing that certain spiritual practices, such as yoga, deep meditation, and prayer, can affect the mind, brain, values Principles that influence our thoughts and emotions and guide the choices we make in our lives spiritual intelligence (SI) The ability to access higher meanings, values, abiding purposes, and unconscious aspects of the self, a characteristic that helps each of us find a moral and ethical path to guide us through life FOCUS ON  |   CULTIVATING YOUR SPIRITUAL HEALTH  |   87 M04_DONA7767_11_GE_C02A.indd 87 31/05/14 10:08 AM www.freebookslides.com body, and behavior in ways that have potential to treat many health problems and to promote healthy behavior.12 Ongoing research is investigating the use of spirituality in treating specific pain conditions, irritable bowel syndrome, insomnia, and more.13 Some researchers believe that a key to understanding the improved health and longer life of spiritually healthy people is mindfulness training In a recent study, participants who practiced mindfulness meditation showed measurable changes in brain regions associated with memory and stress These changes indicate that they may be more likely to cope better with stress on a daily basis.14 The National Cancer Institute (NCI) contends that when we get sick, spiritual or religious well-being may help restore health and improve quality of life in the following ways:15 By decreasing anxiety, depression, anger, discomfort, and feelings of isolation ● By decreasing alcohol and drug abuse ● By decreasing blood pressure and the risk of heart disease ● By increasing the person’s ability to cope with the effects of illness and with medical treatments ● By increasing feelings of hope and optimism, freedom from regret, satisfaction with life, and inner peace ● Several studies show an association between spiritual health and a person’s ability to cope with a variety of physical illnesses as well as with cancer.16 For example, a study of people living with chronic pain and neurological conditions showed a benefit to using spiritual health and mind–body techniques.17 Researchers have also looked into the overall association between spiritual practices and mortality, and a review of over a decade of research studies indicated that individuals who incorporate spiritual practices regularly have a significant reduction in mortality and risk of cardiovascular events.18 Psychological Benefits Current research also suggests that spiritual health contributes to psychological health For instance, the NCI and independent studies have found that spirituality reduces levels of anxiety and depression.19 People who have found a spiritual community also benefit from increased social support among members Participation in religious services, charitable organizations, and social gatherings can help members avoid isolation At such gatherings, clerics and other members may offer spiritual support for challenges that participants may be facing Or a community may have retired members who offer child care for harried parents, meals for members with disabilities, or transportation to those needing to get to medical appointments All such measures can contribute to members’ overall feelings of security and belonging Benefits from Lowered Stress Does spirituality influence health? Spirituality is widely acknowledged to have a positive impact on health and wellness The benefits range from reductions in overall morbidity and mortality to improved abilities to cope with illness and stress These students are using the movement techniques of tai chi to improve their spiritual health The NCI cites stress reduction as one probable mechanism among spiritually healthy people for improved health and longevity and for better coping with illness.20 In addition, several small studies support the ­contention that positive religious practices support effective stress management.21 And a recent study suggests that increasing mindfulness through meditation reduces stress levels not only in people with physical and mental disorders, but also in healthy people.22 88  |   Part one  |   Finding the Right Balance M04_DONA7767_11_GE_C02A.indd 88 31/05/14 10:08 AM www.freebookslides.com What Can You Do to Focus on Your Spiritual Health? Cultivating your spiritual side takes just as much work as becoming physically fit or improving your diet Ways to develop your spiritual health include training your body, expanding your mind, tuning in, and reaching out What’s Working for You?  Maybe you’re already focusing on enhancing your spiritual health Do you incorporate any of the following behaviors into your daily life? u I practice yoga u I meditate u I volunteer work u I maintain healthy relationships Train Your Body For thousands of years, in regions throughout the world, spiritual seekers have cultivated transcendence through physical means One of the foremost examples is the practice of various forms of yoga Although in the West we think of yoga as involving controlled breathing and physical postures, traditional forms also emphasize meditation, chanting, and other practices that Yoga incorporates a variety of poses (called asanas), from energetic to restful This yoga student is performing a restful asana known as the child’s pose are believed to cultivate unity with the Atman, or spiritual life principle of the universe If you are interested in exploring yoga, sign up for a class on campus, at your local YMCA, or at a dedicated yoga center Make sure you choose a form that seems right for you: Some, such as hatha yoga, focus on developing flexibility, deep breathing, and tranquility, whereas others, such as ashtanga yoga, are fast-paced and demanding, and thus focus more on developing physical fitness For your first class, dress comfortably in somewhat close fitting, relaxed fabrics so that when you bend at the waist or lift your leg you won’t feel constricted or exposed No shoes or socks are worn At the beginning of the class, the instructor will likely lead you through some gentle warm-up poses (called asanas) and then add more challenging poses with coordinated inhalations and exhalations to align, stretch, and invigorate each region of your body Most classes provide yoga mats to cushion your joints as you work through the postures Your class will probably conclude with several minutes of relaxation and deep breathing Training your body to improve your spiritual health doesn’t necessarily require you to engage in a formal practice such as yoga By energizing your body and sharpening your mental focus, jogging, biking, aerobics, or any other exercise you every day can contribute to your spiritual health The ancient Eastern meditative movement yoga A system of physical and mental training involving controlled breathing, physical postures (asanas), meditation, chanting, and other practices that are believed to cultivate unity with the Atman, or spiritual life principle of the universe techniques of tai chi or qigong can also increase physical activity, mental focus, and deep breathing Both have been shown to have beneficial effects on bone health, cardiopulmonary fitness, balance, and quality of life.23 To transform an exercise session into a spiritual workout, begin by acknowledging gratitude for your body’s strength and speed, then, throughout the session, try to maintain mindfulness of your breathing We’ll say more about mindful breathing in the discussion of meditation below You can also cultivate spirituality through fully engaging your body’s senses In fact, you can think of vision, hearing, taste, smell, and touch as five portals to spiritual health Viewing an engaging piece of artwork or listening to beautiful music can calm the mind and soothe the spirit The flip side of cultivating your senses is depriving them! Closing your eyes and sitting in silence removes the distraction of visual and auditory stimuli, helping you to focus within To take advantage of silence, turn off your cell phone and take a long, solitary walk You might even spend a weekend at one of the many retreat centers throughout the United States To find one, see the state-bystate listing at www.SpiritSite.com Expand Your Mind For many people, psychological counseling is a first step toward improving spiritual health Therapy helps you let go of the hurts of the past, accept your limitations, manage stress and anger, reduce anxiety and depression, and take control of your life—all of which are also steps toward spiritual growth If you’ve never engaged in therapy, making the first appointment can feel daunting Your campus health department can usually help by providing a referral FOCUS ON  |   CULTIVATING YOUR SPIRITUAL HEALTH  |   89 M04_DONA7767_11_GE_C02A.indd 89 31/05/14 10:08 AM www.freebookslides.com Tune in to Yourself and Your Surroundings Focusing on your spiritual health has been likened to tuning in a radio station: Inner wisdom is perpetually available to us, but if we fail to tune our “receiver,” we won’t be able to hear it for all the “static” of daily life Fortunately, four ancient practices still used throughout the world can help you tune in These are contemplation, mindfulness, meditation, and prayer, which you can think of as studying, observing, quieting, and communing with the Divine Figure Qualities of Mindfulness Another practical way to expand your mind is to study the sacred texts of the world’s major religions and spiritual practices Many seekers find guidance in the writings of great spiritual teachers Libraries and bookstores are filled with volumes that explore the diverse approaches humans take to achieve spiritual fulfillment Finally, you can expand your awareness of different spiritual practices by exploring on-campus meditation groups, taking classes in spirituality or comparative religions, attending meetings of student organizations where different religious tenets are explored, visiting different religious organizations in your local area and noting what spiritual elements they hold in common, attending public lectures and critically evaluating whether the speakers demonstrate a spiritual bent or reflect bias or exclusion in their lectures, and checking out the official websites of spiritual and religious organizations evil? In addition, most religious and spiritual traditions advocate engaging in the contemplation of gratitude, forgiveness, and unconditional love When practicing contemplation, it can be helpful to keep a journal to record any insights that arise In addition, journaling itself can be a form of contemplation For example, you might want to make a list of 20 things in your life that you are grateful for or write a poem of forgiveness for yourself or a loved one You might also use your journal to record inspirational quotations that you encounter in your readings Mindfulness A practice of focused, nonjudgmental observation, mindfulness is the ability to be fully present in the moment (Figure 2) If you have ever Contemplation In a dictionary, the been immersed in a moment, experiword contemplation means a study of encing it completely by using all your something—whether a candle flame senses—sight, hearing, taste, smell, or a theory of quantum m ­ echanics In touch—this is mindfulness Examples the domain of spirituality, contemcan be watching the sun set over a plation usually refers to a practice of mountain, or listening to a great piaconcentrating the mind on a spiritual nist playing Bach, or even performing or ethical question or subject, a view a challenging calculation in math In of the natural world, or an icon or other words, mindfulness is an awareother image representative of divinity ness of present-moment reality—a For instance, a Zen Buddhist might holistic sensation of being totally incontemplate a riddle, called a koan, volved in the moment rather than such as, what is the sound of one hand being focused on some past worry or clapping? A Sufi might contemplate being on “automatic pilot.”24 the 99 names of God A Roman CathoSo how you practice mindfullic might contemplate an image of the ness? The range of opportunities is as Virgin Mary Spiritual people with no infinite as the moments of our everyday religious affiliation might contemlives Living mindfully means to allow plate the natural world, a favorite ourselves to become more deeply and poem, or an ethical question completely aware of what it is we Even such as, what is the origin of are sensing in each moment.25 the most mundane activities—such as peeling an orange—can have spiritual value if done mindfully contemplation A practice of concentrating the mind on a spiritual or ethical question or subject, a view of the natural world, or an icon or other image representative of divinity mindfulness A practice of purposeful, nonjudgmental observation in which we are fully present in the moment 90  |   Part one  |   Finding the Right Balance M04_DONA7767_11_GE_C02A.indd 90 31/05/14 10:08 AM www.freebookslides.com Be Healthy, Be Green Developing Environmental Mindfulness We know that the Earth’s oil reserves won’t last forever, yet in 2011, many American automakers saw their biggest sales increases in large pickups and SUVs We know that beef production releases gobs of greenhouse gases, yet each year Americans consume 26 billion pounds of beef Why we make such choices? We want to “go green,” so what’s in our way? If the environmental movement seems to be running out of steam, many activists say that it’s due to an overemphasis on our external choices, whereas the real challenge is to change our state of mind They argue that until we confront the mental habits and identities that fuel our consumption patterns, meaningful change won’t happen In short, they advocate mindfulness When we pay attention to our thoughts as we make choices, we might notice For instance, the next time you get ready to eat an orange, pay attention! What does it feel like to pierce the skin with your thumbnail? Do you smell the fragrance of the orange as you peel it? What does the rind really look like? How the drops of juice splatter as you separate the orange into segments? And finally, what does it taste like, and how does the taste change from the first bite to the last? Pursuing almost any endeavor that requires close concentration can what you think? Why you think mindfulness practices are gaining more recognition? ● What are the benefits of mindfulness? ● In today’s fast-paced, multitasking world, you think it is challenging to practice mindfulness on a regular basis? of these “inner demons” can we begin to take action to expel them So how we cultivate environmental mindfulness? In her book Mindfully Green, environmentalist Stephanie Kaza advises us to ask ourselves a set of troubling questions, such as: What I actually need? What is my fair share? Am I willing to witness suffering? She explains that mindfulness requires us to stay present with our actions moment by moment, always asking, “What is the kind thing to now?” To be mindfully green requires us to ask ourselves some tough questions, such as, what is my fair share? And how much I really need? guilt, insecurity, disparagement of ourselves or others, or even righteous claims to entitlement Only by becoming aware help you develop mindfulness For instance, think of physical and mental challenges, such as a competitive diver leaping from the board or a physician attempting a difficult diagnosis Or consider creative and performing arts such as sculpting, painting, writing, dancing, or playing a musical instrument Even household activities such as cooking or cleaning can foster mindfulness—as long as you pay attention while you them In this era of global environmental concerns, we can also cultivate mindfulness by paying attention to how our choices affect our world This doesn’t only mean mindfulness about recycling our soda cans and taking the subway instead of our car Those are the easy examples Instead, mindfulness of our environment calls on us to examine our values and behaviors as we share our Earth every moment of each day The Be Healthy, Be Green box will help you begin Source: D Drubin and T Krishner, “SUVs, Trucks Lift Auto Sales,” Associated Press, October 3, 2011; Economic Research Service, U.S Department of Agriculture, “U.S Beef and Cattle Industry,” May 2011, www.ers.usda gov; E Nichtern, The Psychology of Ecology: Exploring the Internal Landscape of Consumption (Stockbridge, MA: Kripalu Center, 2008); S Kaza, Mindfully Green (Boston, MA: Shambhala Publications, 2008) How can I stick with a meditation routine? Professor Adam Burke, Director of San Francisco State’s Institute for Holistic Health Studies, says that the key to sticking with meditation is choosing a technique that you like He points out that there are a variety of different meditation techniques, and it is important to pick the one that works best for you FOCUS ON  |   CULTIVATING YOUR SPIRITUAL HEALTH  |   91 M04_DONA7767_11_GE_C02A.indd 91 31/05/14 10:08 AM www.freebookslides.com See It! Videos Is meditation a key to happiness? Watch Meditating to Happiness in the Study Area of Meditation Meditation is a practice of cultivating a still or quiet mind Although the precise details vary with different schools of meditation, the fundamental task is the same: to quiet the mind’s noise (variously referred to as “chatter,” “static,” or “monkey mind”) Why would you want to cultivate the stillness of meditation? For thousands of years, human beings of different cultures and traditions have found that achieving periods of meditative stillness each day enhances their spiritual health Today, researchers are beginning to discover why The NCCAM reports that researchers using brainscanning techniques have found that experienced meditators show a significantly increased level of empathy, the ability to understand and share another person’s experience.26 Similarly, another recent study found that participants who practiced a specific form of meditation, known as compassion-meditation, increased their levels of compassion toward others.27 There are physical benefits, too Studies suggest that meditation reduces stress, anxiety, and depression.28 The physiological processes that produce these effects are only partially understood One theory suggests meditation works by reducing the body’s stress response When under stress, the body reacts by raising heart rate, increasing breaths, and constricting blood vessels Over the long run, too much stress can lead to both increased wear and tear on the body and a harried, exhausted outlook on life.29 By practicing deep, calm contemplation, people who meditate seem to promote activity in the body’s systems, which leads to slower breathing, lower blood pressure, and easier digestion, along with the spiritual benefits So how you meditate? Detailed instructions are beyond the scope of this text, but most teachers advise beginning by sitting in a quiet place with ●   Candle meditation low lighting where you can be certain With your eyes open, you won’t be interrupted Many focus on the flame of advocate assuming a “full “Why a candle Allow your lotus” position, with eyes to soften as both legs bent fully at Should you meditate on the knees and each I Care?” this object Treat ankle over the opdistractions as in posite knee HowPracticing meditation can improve your brain’s ability to process the other forms of ever, this position information, reduce your stress meditation can be painful for level, and improve your sleep, beginners, people all important factors when After several with poor flexibiltrying to manage your minutes of meditaity, and people with classes and handle tion, and with pracjoint pain Thus, you daily demands tice, you may come to may want to assume a experience a sensation modified lotus position, sometimes described as “dropin which your legs are simply ping down,” in which you feel yourself crossed in front of you Lying down is release into the meditation In this not recommended because you may state, which can be likened to a wakefall asleep Rest your hands palm upful sleep, distracting thoughts are far ward on your knees This position unless likely to arise, and yet you may crosses the two bones of the forearm suddenly receive surprising insights Your eyes can be open, half-open, or When you’re beginning, try mediclosed, but if you are a beginner, you tating for 10 to 20 minutes a session, may find it easier to meditate with your once or twice a day In time, you can eyes closed increase your sessions to 30 minutes Once you’re in a position conducive or more As you meditate for longer to meditation, it’s time to start quietperiods, you will likely find yourself ing your mind Different schools of feeling more rested and less stressed meditation teach different methods to throughout your day, and you may achieve this begin to experience the increased lev● Mantra meditation Focus on a manels of empathy reported among expert tra, a single word such as Om, Amen, meditators Love, or God Repeat this word silently to yourself When a distracting thought arises, simply set it aside It may help to imagine the thought as a leaf, and mentally let it fall on a gently flowing stream that carries it away Do not fault yourself for becoming distracted Simply notice the thought, release it, and return to your mantra ● Breath meditation Count each breath: Pay attention to each inhalation, the brief pause that follows, and the exhalation Together, these equal one breath When you have counted ten breaths, return to one As with mantra meditation, as distractions arise, release them and return to following the breath ●   Color meditation When your eyes are closed, you may perceive a field Volunteering can be a fun and fulfilling way to of color, such as a deep, restful blue broaden your experience, connect with your Focus on this color Treat distractions community, and focus on your spiritual health as in the other forms of meditation 92  |   Part one  |   Finding the Right Balance M04_DONA7767_11_GE_C02A.indd 92 31/05/14 10:08 AM 26% of young adults under the age of 30 reported that they meditate at least once a week Prayer In prayer, an individual focuses the mind in communication with a transcendent Presence Spiritual traditions throughout the world distinguish several forms that this communication can take For many, prayer offers a sense of comfort; a sense that we are not alone; and an avenue for expressing concern for others, for admission of transgressions, for seeking forgiveness, and for renewing hope and purpose Focusing on the things we can be grateful for in life can move people to look to the future with hope and give them the strength to get through the most challenging times Reach Out to Others Finding Your Spiritual Side through Service Recognizing that we are all part of a greater system and that we have responsibilities to and for others is a key part of spiritual growth Volunteering your time and energy is a great way to connect with others and help make the world a better place while improving your own health Here are a few ideas: ❱ Offer to help elderly neighbors by providing lawn care or helping with simple household repairs ❱ Volunteer with Meals on Wheels, a local soup kitchen, food bank, or other program that helps neighbors obtain adequate food ❱ Organize or participate in an after-school or summertime activity for neighborhood children ❱ Participate in a highway, beach, or neighborhood cleanup; restoration of park trails and waterways; or other environmental preservation projects ❱ Volunteer at the local humane society walking dogs, caring for cats, helping with cleaning, or raising money for shelter programs ❱ Become a Big Brother or Big Sister and mentor a child who may face significant challenges or have poor role models ❱ Join an organization working on a cause such as global warming or hunger, or start one yourself ❱ Spend time volunteering in a neighborhood challenged by poverty, low literacy levels, or a natural disaster Or volunteer with an organization such as Habitat for Humanity to build homes or provide other aid to developing communities aspect of a spiritually healthy life­ style Volunteering to help others, working for a nonprofit organization, donating money or other resources to a food bank or other program— even spending an afternoon picking up litter in Did you know? According to one your neighborAccording to one national survey, 49% hood—are all national survey, 49% ways to serve othof Americans use of Americans use ers and simultaprayer for health prayer for health reaneously enhance reasons your own spirsons itual and overall health Researchers have referred to the benefits of volunteering as a “helpers high,” or a distinct physical sensation associated with helping About half of participants Source: A Wachholtz and U Sambamoorthi, “National trends in prayer use as in one study rea coping mechanism for health concerns: Changes from 2002 to 2007,” Psychology of Religion and Spirituality 3, no (2011): 67, doi 10.1037/a0021598 ported that they Altruism, the giving of oneself out of genuine concern for others, is a key Skills for Behavior Change www.freebookslides.com feel stronger and more energetic after helping others; many also reported feeling calmer and less depressed, with increased feelings of self-worth.30 Community service can also take the form of environmental stewardship, which the Environmental Protection Agency (EPA) defines as the responsibility for environmental quality shared by all those whose actions affect the environment Responsibility manifests in action Simple actions such as reducing and recycling packaging, turning off lights, making sure the heat or air-conditioning maintains an ecofriendly temperature, using energy-efficient lightbulbs and appliances, and taking shorter showers can make a difference For more strategies to enhance your spiritual health, refer to the Skills for ­Behavior Change box prayer Communication with a transcendent Presence altruism The giving of oneself out of genuine concern for others environmental stewardship Responsibility for environmental quality shared by all those whose actions affect the environment FOCUS ON  |   CULTIVATING YOUR SPIRITUAL HEALTH  |   93 M04_DONA7767_11_GE_C02A.indd 93 31/05/14 10:08 AM www.freebookslides.com Assessyourself What’s Your Spiritual IQ? Live It! Assess Yourself An interactive version of this assessment is available online in Many tools are available for assessing your spiritual intelligence Although each differs significantly according to its target audience (therapy clients, business executives, church members, etc.), most share certain underlying principles reflected in the questionnaire below Answer each question as follows:    7. I meditate or pray daily = not at all true for me = somewhat true for me = very true for me    8. I frequently and fearlessly ponder the possibility of an afterlife   1. I frequently feel gratitude for the many blessings of my life    9. I accept total responsibility for the choices that I have made in building my life   2. I am often moved by the beauty of Earth, music, poetry, or other aspects of my daily life   10. I feel that I am on Earth for a unique and sacred reason   3. I readily express forgiveness toward those whose missteps have affected me   4. I recognize in others qualities that are more important than their appearance and behaviors   5. When I poorly on an exam, lose an important game, or am rejected in a relationship, I am able to know that the experience does not define who I am   6. When fear arises, I am able to know that I am eternally safe and loved S c o r in g The higher your score on this quiz, the higher your spiritual intelligence To improve your score, apply the suggestions for spiritual practices from this chapter Y o u r P l a n F o r cha n g e Assessyourself The activity gave you the chance to evaluate your spiritual intelligence, and the chapter introduced you to practices used successfully by millions of people over many generations to enhance their spiritual health If you are interested in cultivating your own spirituality further, consider taking some of the small but significant steps listed below Today, you can: ○ Find a quiet spot; turn off your cell phone; close your eyes; and contemplate, meditate, or pray for 10 minutes Or spend 10 minutes in quiet mindfulness of your surroundings ○ In a journal or on your computer, begin a numbered list of things you are grateful for Today, list at least ten things Include people, pets, talents and abilities, achievements, favorite places, foods  .  whatever comes to mind! Within the next weeks, you can: ○ Explore the options on campus for beginning psychotherapy, joining a spiritual or religious student group, or volunteering with a student organization working for positive change ○ Think of a person in your life with whom you have experienced conflict Spend a few minutes contemplating forgiveness toward this person and then write him or her an e-mail or letter apologizing for any offense you may have given and offering your forgiveness in return Wait for a day or two before deciding whether you are truly ready to send the message By the end of the semester, you can: ○ Develop a list of several spiritual texts that you would like to read during your break ○ Begin exploring options for volunteer work next summer 94  |   Part one  |   Finding the Right Balance M04_DONA7767_11_GE_C02A.indd 94 31/05/14 10:09 AM www.freebookslides.com Managing Stress and Coping with Life’s Challenges Learning Outcomes ✱ Define stress and examine its potential impact on health, relationships, and success in college and life ✱ Explain the phases of the general adaptation syndrome and the physiological changes that occur during them ✱ Examine the physical and psychological health risks that may occur with chronic stress ✱ Examine the intellectual health risks that may occur due to high levels of stress ✱ Discuss sources of stress and examine the unique stressors that affect college students ✱ Explore stress-management and stress reduction strategies, ways you can cope more effectively with stress, and ways you can enrich your life experiences to protect against the effects of stress 97 Isn’t some stress healthy? 104 Who is most prone to stress? 108 Are college students more stressed out than other groups? 113 Can reducing clutter help me de-stress in college? 95 M05_DONA7767_11_GE_C03.indd 95 31/05/14 10:08 AM S www.freebookslides.com Skyrocketing tuition, roommates and friends who bug you, anxiety over fitting in, dating, pressure to get good grades, money, and worries about getting a job after graduation— they all lead to STRESS! In today’s fast-paced, 24/7-connected world, stress can cause us to feel overwhelmed and zap our energy It can also cause us to push ourselves to improve performance, bring excitement, and help us thrive According to a recent American Psychological Association study, chronic stress that interferes with our ability to function normally over an extended period has become a public health crisis, particularly among caregivers and people living with a chronic illness such as obesity or depression Key findings from the study indicate the following1: Although reported stress levels are down slightly in the last years, Americans consistently report high stress levels (22% report extreme stress) ● Adults ages 18–46 report the highest levels of stress and the greatest increases in stress levels ● Biggest sources of stress for adults ages 18–32 are money (80%), work (72%), and housing costs (49%) Individuals aged 66 and older were more likely to cite their families’ health problems as a key source of stress (63%) ● Huge gender differences exist in how men and women experience and cope with stress, with women being more vulnerable to negative effects of stress Although men may recognize and report stress, they are much less likely to take action to reduce it.)2 Stress levels have increased 10% to 30% In the most recent National College Health Assessment, 28.3% of college students reported that stress negatively affected their individual academic performance during the last school year, resulting in a lower grade, a dropped class, or an incomplete This was the number one factor that had an impact on student performance Source: Data from American College Health Association, American College Health Association—National College Health Assessment II, Reference Group ­Report, Fall 2012 (Hanover, MD: American College Health ­Association, 2013) sleeping too much, and too much television, which in turn contributes to weight gain and more stress.3 Is too much stress inevitably negative? Fortunately, the answer is no How we react to real and perceived threats often is key to whether stressors are enabling or debilitating Learning to assess our perceptions and to anticipate, avoid, and develop skills to reduce or better manage those stressors is key First, we must understand what stress is since 1983 The exact toll stress exerts on us during a lifetime is unknown, but we know stress is a significant health hazard It can rob the body of needed nutrients, damage the cardiovascular system, raise blood pressure, increase our risks for cancer and diabetes, and dampen the immune system’s defenses In addition, it can drain our emotional reserves and contribute to depression, anxiety, fatigue, and irritability, impacting relationships with friends, family, and coworkers It can also leave us sleep deprived and functioning at a fraction of our normal capacity Importantly, research indicates that being “stressed out” can take a major toll among even the young, with youth suffering stress A series of mental and physifrom stress-related headaches, ological responses and adaptations stomachaches, difficulty sleeping, to a real or perceived threat to one’s or other illnesses at increasing well-being rates Stress seems to be a particustressor A physical, social, or psylar threat to youth who are overchological event or condition that upsets homeostasis and produces a weight The higher the stress, the stress response greater the chances of overeating, What Is Stress? Most current definitions state that stress is the mental and physical response and adaptation by our bodies to real or perceived change and challenges A stressor is any real or perceived physical, social, or psychological event or stimulus that causes our bodies to react or respond.4 Several factors influence one’s response to stressors, including characteristics of the stressor (How traumatic is it? Can you control it? Does it occur often?); biological factors (e.g., your age or gender); and past experiences (e.g., things that have happened to you, their consequences, and your response) Stressors may be tangible, such as a failing grade on a test, or intangible, such as the angst associated with meeting your significant other’s parents for the first time Importantly, stress is in the eye of the beholder: Your unique combination of heredity, life experiences, personality, and ability to cope influence your perceptions and the meaning you attach to them What “stresses you out” may not even bother others 96  |   Part one  |   Finding the Right Balance M05_DONA7767_11_GE_C03.indd 96 31/05/14 10:08 AM www.freebookslides.com with wild, acute stress Individu- eustress Stress that presents opporals experiencing episodic acute tunities for personal growth; positive stress may be “repeaters” and stress talk continually about stressors distress Stress that can have a They may be worrywarts who see detrimental effect on health; negative stress the world not as a place of “what acute stress The short-term physiis,” but rather as one of “what-ifs” ological response to an immediate where bad things are always lurk- perceived threat ing These “awfulizers” are often episodic acute stress The state reactive and anxious, but these of regularly reacting with wild, acute patterns can be so habitual, they stress about one thing or another don’t realize that there is anything chronic stress An ongoing state wrong Acute and episodic acute of physiological arousal in response to ongoing or numerous perceived stress both can cause physical and threats emotional problems But chronic traumatic stress A physiological stress, which may not appear as and mental response that occurs for intense but can linger indefinitely, a prolonged period of time after a wreaks silent havoc on your body major accident, war, assault, natural systems Losing your mother after disaster, or an event in which one may be seriously hurt, killed, or witness her long battle with breast cancer horrible things can cause the stress response to homeostasis A balanced physireverberate in you for months after ological state in which all the body’s her death, causing you to struggle systems function smoothly to balance emotions such as anger, adaptive response The physiological grief, loneliness, and guilt while adjustments the body makes in an attrying to keep up with classes tempt to restore homeostasis and life Another type of stress, traumatic stress, is experienced when events such as major accidents, war, shootings, assault, or natural disasters occur and you may be hurt or witness horrible things Effects of traumatic stress may be felt for years after the event and cause significant disability, which may lead to post-traumatic stress disorder or PTSD (see Chapter for a discussion of PTSD).6 Isn’t some stress healthy? Stress isn’t necessarily bad for you Events that cause eustress, such as the birth of a child, can have positive effects on your growth and well-being Generally, positive stress is called eustress Eustress presents the opportunity for personal growth and satisfaction and can actually improve health It can energize you, motivate you, and raise you up when you are down Getting married or winning a major competition can give rise to the pleasurable rush associated with eustress Distress, or negative stress, is caused by events that result in debilitative tension and strain, such as financial problems, the death of a loved one, academic difficulties, or ending a relationship There are several kinds of distress The most common type, acute stress, comes from demands and pressures of the recent past and anticipated demands and pressures of the near future.5 Usually, acute stress is intense, lasts for a short time, and disappears quickly without permanent damage to your health A major class presentation or meeting the person you’ve been chatting with online for the first time could cause trembling, nausea, headache, cramping, or diarrhea, along with a galloping heartbeat A second type of stress is episodic acute stress, which describes the state of regularly reacting Your Body’s Stress Response The body’s physiological responses to stressors evolved to protect humans from harm Thousands of years ago, if you didn’t respond by fighting or fleeing, you might have been eaten by a saber-toothed tiger or killed by a marauding enemy clan Today, these same responses must be managed rather than causing us to lash out at others Continually having to “stuff” our reactions rather than letting our physiological responses run their course can harm our health over time The General Adaptation Syndrome When stress levels are low, the body is often in a state of homeostasis or balance; all body systems are operating smoothly to maintain equilibrium Stressors trigger a crisis-mode physiological response, after which the body attempts to return to homeostasis by means of an adaptive response First characterized by Hans Selye in 1936, the Chapter 3  |   Managing Stress and Coping with Life’s Challenges  |   97 M05_DONA7767_11_GE_C03.indd 97 31/05/14 10:08 AM www.freebookslides.com Hear It! Podcasts Resistance stage: Adaptation resources are mobilized to combat stressor, and body maintains a higher level of resistance Resistance to stress Alarm stage: Stressor disrupts body’s stability, temporarily lowering resistance Exhaustion stage: Body runs out of adaptation energy stores for adjusting to stressor, and resistance drops below normal Homeostasis (normal state of resistance) Time 3.1 Figure The General Adaptation Syndrome (GAS) The GAS describes the body’s method of coping with prolonged stress internal fight to restore homeostasis in the face of a stressor is known as the general adaptation syndrome (GAS) (Figure 3.1) The GAS has three distinct phases: alarm, resistance, and exhaustion.7 Regardless of whether you are general adaptation syndrome experiencing distress or eustress, (GAS) The pattern followed in the similar physiological changes will physiological response to stress, conoccur in your body In addition, the sisting of the alarm, resistance, and GAS can occur in varying degrees exhaustion phases of intensity, last varying amounts fight-or-flight response of time, and be experienced differPhysiological arousal response in which the body prepares to combat or ently by different individuals escape a real or perceived threat autonomic nervous system (ANS) The portion of the central nervous system that regulates body functions that a person does not normally consciously control sympathetic nervous system Branch of the autonomic nervous system responsible for stress arousal parasympathetic nervous system Branch of the autonomic nervous system responsible for slowing systems stimulated by the stress response hypothalamus A structure in the brain that controls the sympathetic nervous system and directs the stress response epinephrine Also called adrenaline, a hormone that stimulates body systems in response to stress cortisol Hormone released by the adrenal glands that makes stored nutrients more readily available to meet energy demands Alarm Phase Suppose you are walking to your residence hall after a night class on a dimly lit campus As you pass a particularly dark area, you hear a cough and feel someone approaching rapidly behind you You walk faster, only to hear the quickened footsteps of the other person Your senses become increasingly alert, your breathing quickens, your heart races, and you begin to perspire In desperation you wheel around and let out a blood-curdling yell To your surprise, the only person you see is a classmate: She has been trying to stay close to you out of her own anxiety about walking alone in the dark She screams and jumps backward, and you both burst out laughWant a study podcast for this ing in startled embarchapter? Download the podrassment You have just cast Managing Stress: Coping experienced the alarm with Life’s Challenges in the Study Area of phase of GAS Also known as the fight-orflight response, this physiological reaction is one of our most basic, innate survival instincts8 (see Figure 3.2 on page 99) When the mind perceives a real or imaginary stressor, the cerebral cortex, the region of the brain that interprets the nature of an event, triggers an autonomic nervous system (ANS) response that prepares the body for action The ANS is the portion of the nervous system that regulates body functions that we not normally consciously control, such as heart and glandular functions and breathing The ANS has two branches: sympathetic and parasympathetic The sympathetic nervous system energizes the body for fight or flight by signaling the release of several stress hormones The parasympathetic nervous system slows systems stimulated by the stress response—in effect, it counteracts the actions of the sympathetic branch The responses of the sympathetic nervous system to stress involve a series of biochemical exchanges between different parts of the body The hypothalamus, a structure in the brain, functions as the control center of the sympathetic nervous system and determines the overall reaction to stressors When the hypothalamus perceives that extra energy is needed to fight a stressor, it stimulates the adrenal glands, located near the top of the kidneys, to release the hormone epinephrine, also called adrenaline Epinephrine causes more blood to be pumped with each beat of the heart, dilates the airways in the lungs to increase oxygen intake, increases the breathing rate, stimulates the liver to release more glucose (which fuels muscular exertion), and dilates the pupils to improve visual sensitivity It revs the body for action In addition to the fight-or-flight response, the alarm phase can trigger a longer-term reaction to stress The hypothalamus uses chemical messages to trigger the pituitary gland within the brain to release a powerful hormone, adrenocorticotropic hormone (ACTH) ACTH signals the adrenal glands to release cortisol, a hormone that makes stored nutrients more readily available to meet energy demands Finally, other parts of the brain and body release endorphins, which relieve pain that a stressor may cause Resistance Phase In the resistance phase of the GAS, the body tries to return to homeostasis by resisting the alarm responses However, because some perceived stressor still exists, the body does not achieve complete calm or rest Instead, the body stays activated or aroused at a level that causes a higher metabolic rate in some organ tissues For example, you get a lockdown alert because a shooter is on campus, and your fear response triggers an acute alarm reaction As you hear that the shooter has been subdued, you may calm down a bit, but your body may not return to normal until the all clear has sounded and you are safe at home 98  |   Part one  |   Finding the Right Balance M05_DONA7767_11_GE_C03.indd 98 31/05/14 10:08 AM www.freebookslides.com More blood flows to brain; senses sharpen Pupils dilate to bring in more light and increase visual perception Hearing ability increases Salivation decreases Perspiration increases Respiration rate increases Heart rate and blood pressure increase Digestive system slows as blood supply is diverted to more critical areas Liver and fat tissues release energy-producing substances (such as glucose) into bloodstream Blood-clotting ability increases More blood flows to muscles; muscles tense Immune system activity decreases Urine production decreases 3.2 Figure The Body’s Acute Stress Response Exposure to stress of any kind causes a complex series of involuntary physiological responses Video Tutor: Body’s Stress Response Exhaustion Phase A prolonged effort to adapt to an acute, episodic, or chronic stress response leads to allostatic load, or exhaustive wear and tear on the body In the exhaustion phase of GAS, the physical and emotional energy used to fight a stressor has been depleted You may feel tired or drained When stress is chronic or unresolved, the body typically begins to adjust by prompting the adrenal glands to continue releasing 50% of older U.S men who have had moderate to high levels of stress in their lives over the years have an cortisol and other stress hormones, allostatic load Wear and tear on the which remain in the bloodstream, body caused by prolonged or exceskeeping you wired for longer peri- sive stress responses ods of time as a result of slower met- immunocompetence The ability abolic responsiveness Over time, of the immune system to respond to attack excessive cortisol can reduce immunocompetence, or the ability of the immune system to protect you from infectious diseases and other threats to health.9 Lifetime Effects of Stress increased risk of death Stress is often described as a “disease of prolonged arousal” that leads to a cascade of negative health effects The longer you are chronically stressed, the more likely there will be Chapter 3  |   Managing Stress and Coping with Life’s Challenges  |   99 M05_DONA7767_11_GE_C03.indd 99 31/05/14 10:08 AM ... from the British Library 10 15 14 13 12 11 Typeset by Cenveo Publisher Services/Nesbitt Graphics A 01_ DONA7767 _11 _GE_FM.indd 04/06 /14 6:54 PM Brief Contents 10 Reaching and Maintaining a Healthy... improve the health of all groups ● Chapter 1? ?? |   Accessing Your Health? ?? |   31 M 01_ DONA7767 _11 _GE_C 01. indd 31 31/ 05 /14 9: 31 AM Determ Individual behavior Policymaking Biology and genetics Health. .. world rejected the old medical model Chapter 1? ?? |   Accessing Your Health? ?? |   29 M 01_ DONA7767 _11 _GE_C 01. indd 29 31/ 05 /14 9: 31 AM The Ten Greatest Public Health Achievements of the 20th Century