Chapter 7 Physical Disorders and Health Psychology Psychological

Chapter 7 Physical Disorders and Health Psychology

Psychological and Social Factors that Influence Health • Psychological, behavioral, and social factors – Are major contributors to medical illness and disease – Examples • Genital herpes, AIDS, cancer, cardiovascular diseases

Psychological and Social Factors that Influence Health • DSM-IV-TR and physical disorders – Coded on Axis III – Recognize that psychological factors affect medical conditions • Psychological approaches to health and disease – Behavioral medicine – study of factors affecting medical illness – Health psychology – promotion of health

How Do Psychological and Social Factors Influence Medical Illness? • Two primary paths – Psychological factors can influence basic biological processes – Long-standing behavior patterns may put people at risk for disease • AIDS is an example of both forms of influence • Leading causes of death in the U. S. – 50% are linked to lifestyle and behavior patterns

Overview of Stress and the Stress Response • Nature of stress – Stress – physiological response of an individual – Stressor – event that evokes stress response – Stress responses vary from person to person

Overview of Stress and the Stress Response • The stress response and the general adaptation syndrome (GAS) – Phase 1 – alarm response (sympathetic arousal) – Phase 2 – resistance (mobilized coping and action) – Phase 3 – exhaustion (chronic stress, permanent damage)

Physiology of Stress • The biology of stress – Activates the sympathetic branch of the ANS – Neuromodulators and neuropeptides act like neurotransmitters – Activates the HPA axis, producing cortisol – The relation between the hippocampus and HPA activation

Physiology of Stress • The function of the hippocampus in HPA-stress response cycle – Part of the limbic system – Highly responsive to cortisol – Hippocampus helps to turn off the HPA cycle – Chronic stress may damage cells in the hippocampus – Damage to hippocampal cells interferes with stopping the HPA loop

Stress, Anxiety, and Excitement • Primate research: High and low social status – High cortisol is associated with low social status – Low social status – fewer lymphocytes and immune suppression – Dominant males benefit from predictability and controllability

Stress, Anxiety, and Excitement • Vulnerabilities in mental illness contribute to physical illness – Stress – Perceived uncontrollability, low social support, negative affect • Interpretation of physiological response and situation – Seems critical in the stress response – The role of self-efficacy

Stress and the Immune Response • Divisions of the immune system – Humoral branch • Blood and other bodily fluids – Cellular branch • Protects against viral and parasitic infections • Function of the immune system – Identify and eliminate antigens from the body – Leukocytes are the primary agents

Stress and the Immune System: The Role of Leukocytes • Leukocytes: subtypes and functions – Macrophages • First line of defense, destroy antigens, signal lymphocytes – Lymphocytes • B cells (humoral branch) and T cells (cellular branch) – B cells produce antibodies, but T cells do not – Functional role of B and T cells and associated memory cells

Stress and the Immune System: The Role of Leukocytes • Stress dramatically and quickly alters immune function • Autoimmune disease • Rheumatoid arthritis • Psychoneuroimmunology (PNI)

Acquired Immunodeficiency Virus (AIDS) • Nature of AIDS – 33. 4 million cases in 2008 – Course from HIV to full blown AIDS is variable – Median time from initial infection to full-blown AIDS? • 7. 3 to 10 years or more – Stress of getting an AIDS diagnosis can be devastating – AIDS-related complex (ARC) – HAART

Acquired Immunodeficiency Virus (AIDS) • Role of stress reduction programs – Higher stress and low social support speed disease progression – Reduce stress, improve immune system functioning • The development and course of AIDS – Influenced by psychological, behavioral, and social factors

Cancer: Psychological and Social Influences • Field of psychoncology – Study of psychological factors and their relation to cancer • Psychological and behavioral contributions to cancer – Perceived lack of control – Inadequate or inappropriate coping responses (e. g. , denial)

Cancer: Psychological and Social Influences – Overwhelming, stressful life events – Lifestyle risk behaviors – Psychological factors also are involved in chemotherapy • Cancer is influenced by psychological, behavioral, and social factors

Breast Cancer Support and Education • Women with… – – – low self-esteem low body image, feelings of low control low optimism a lack of support at home • …were even more likely to benefit from an education intervention

Cardiovascular Problems: Hypertension • Cardiovascular system: An overview – Heart and blood vessels – Mechanisms for regulating their function • Hypertension – high blood pressure – Major risk factor for stroke, heart disease, and kidney disease – Causes wear and tear of the blood vessels – Essential hypertension is the most common form

Cardiovascular Problems: Hypertension • Contributing factors and associated features – Affects 27. 6% of all adults (between ages of 35 and 64) – 29% for everyone over 18 years – African Americans are most at risk – Affected by salt, fluid volume, sympathetic arousal, and stress – Psychological contributors include anger and hostility • Influenced by psychological, behavioral, and social factors

Cardiovascular Diseases: Coronary Heart Disease (CHD) • Coronary heart disease (CHD) – Blockage of the arteries supplying blood to the heart muscle – Angina pectoris • Chest pain from partial obstruction of the arteries – Atherosclerosis • Accumulation of artery plaque (i. e. , fatty substances) – Ischemia • Deficiency of blood supply because of too much plaque – Myocardial infarction • Heart attack involving death of heart tissue

Cardiovascular Diseases: CHD • Psychological and behavioral risk factors for CHD – Stress, anxiety, anger, – Poor coping skills – Low social support – Lifestyle factors (e. g. , smoking, diet, exercise) – Classic type A behavior pattern • Anger and negative affect • Impatience, accelerated speech and motor activity

Cardiovascular Diseases: CHD • The role of chronic negative emotions • CHD is influenced by psychological, behavioral, and social factors

Chronic Pain • Acute vs. chronic pain – Acute pain vs. chronic pain – Severity of pain does not predict one’s reaction to it • Pain: Some clinical distinctions – Subjective vs. overt behavioral manifestations of pain

Chronic Pain • Psychological and social aspects of pain – Perceived control over pain and its consequences – Negative emotion, poor coping skills – Low social support, compensation – Social reinforcement for pain behaviors • Gate control theory: An integrative account • The role of endogenous opioids

Chronic Pain • Biological aspects of pain – Gate control theory: An integrative account – The role of endogenous opioids – Gender differences in pain

Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences • Nature of chronic fatigue (CF) – Lack of energy, marked fatigue, pain, low-grade fever – Most common in females – Incidence increasing in Western countries – Unrelated to viral infection, immune problems, depression

Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences • Speculation about causes – High-achievement oriented lifestyle – Fast paced lifestyle combines with stress and illness – Psychological misinterpretation of consequences of illness

Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influence • Treatment – Medications are ineffective – Cognitive-behavioral interventions appear promising

Psychosocial Treatment of Physical Disorders • Biofeedback: An overview – Patient learns to control bodily responses – Used with chronic headache and hypertension • Relaxation and meditation – Progressive muscle relaxation – Transcendental meditation (TM)

Psychosocial Treatment of Physical Disorders • Comprehensive stress reduction and pain management programs – More effective and durable than individual interventions alone – Drugs and Stress-reduction programs – Denial as a means of coping

Modifying Behaviors to Promote Health • Lifestyle practices – core of many health problems – Behavioral risk factors are also influenced by psychosocial factors – Prevention and intervention programs target behavioral risks

Modifying Behaviors to Promote Health • Types of lifestyle behaviors – Injury and injury prevention • Repeated warnings are not enough – AIDS prevention • Highly preventable by changing behaviors – Diet, exercise, promotion of health and wellness – Stanford Three Community Study

Summary of Physical Disorders and Health Psychology • Psychological factors play a major role in physical disorders – Behavioral medicine and health psychology • Psychological and social factors: Their role in illness and disease – Stress, immune function, and disease – Such influences interact with other psychosocial factors

Summary of Physical Disorders and Health Psychology • Risk for physical illness – Related to long-standing patterns of behavior & lifestyle factors • Psychosocial treatments – Aim to prevent and/or treat physical disorders – Comprehensive individual or community programs are best

DSM-5 Proposed Changes • http: //www. dsm 5. org/Proposed. Revisions/Pag es/Other. Clinical. Conditions. That. May. Bea. Focuso f. Clinical. Attention. aspx