Chapter 5 Psychology and Physical Health

1. Chapter 5 Psychology and Physical Health

2. Stress, Personality, and Illness, continued • Health psychology is “concerned with how psychological factors relate to the promotion and maintenance of health, and with the causation, prevention, and treatment of illness”. • The biopsychosocial model “holds that illness is caused by a complex interaction of biological, psychological, and sociocultural factors”.

3. Stress, Personality, and Illness, continued • Personality, emotions, and heart disease • Coronary heart disease – “results from a reduction in blood flow through the coronary arteries, which supply the heart with blood”. • Atherosclerosis – “is a gradual narrowing of the coronary arteries” (see Figure 5.3).

4. Figure 5.3 Atherosclerosis. Atherosclerosis, a narrowing of the coronary arteries, is the principal cause of coronary disease. (a) A normal artery. (b) Fatty deposits, cholesterol, and cellular debris on the walls of the artery have narrowed the path for blood flow. (c) Advanced atherosclerosis. In this situation, a blood clot might suddenly block the flow of blood through the artery.

5. Stress, Personality, and Illness, continued • Hostility and coronary risk • Research suggests a link between coronary risk and a behavior pattern termed theType A personality. • Type A personality has three components: • A competitive orientation. • Impatience and a sense of time urgency. • Anger and hostility.

6. Stress, Personality, and Illness, continued Hostility and coronary risk, continued • The “anger – hostility” component of Type A behavior has the strongest link to coronary disease. • Research shows that individuals with above-average hostility scores were twice as likely to haveatherosclerosisthan were those with below-average hostility scores (see Figure 5.5).

7. Figure 5.5. Anger and coronary risk. Working with a large sample of healthy men and women who were followed for a median of 4.5 years, Williams et al. (2000) found an association between trait anger and the likelihood of a coronary event. Among subjects who manifested normal blood pressure at the beginning of the study, a moderate anger level was associated with a 36% increase in coronary attacks, and a high level of anger nearly tripled participants’ risk for coronary disease. (Based on data in William et al., 2000)

8. Stress, Personality, and Illness, continued • Emotional reactions and heart disease • Stress, and its resulting strong emotions, seems to tax the heart. • Even brief periods of stress can trigger acute cardiac symptoms such as angina (chest pain). • When interviewed after surviving a heart attack, many patients say that an episode of anger triggered the symptoms.

9. Stress, Personality, and Illness, continued • Depression and heart disease • Recent studies suggest that the emotional dysfunction of depression may cause heart disease (Goldston & Baillie, 2008). • Overall, it seems that depression doubles one’s chances of developing heart disease. • Depression also seems to affect how heart disease progresses and is associated with worse outcomes in cardiology patients.

10. Stress, Personality, and Illness, continued • Stress and cancer • Cancer – refers “to malignant cell growth, which may occur in many organ systems in the body”. • There is no direct evidence that stress causes the onset of cancer. • However, stress and personality can affect the course of the disease.

11. Stress, Personality, and Illness, continued Stress and cancer, continued • There may be a cancer-prone personality (Type C). • These individuals • Are passive. • Do not complain. • Do not cope well with stress. • Hold in negative emotions, such as anger.

12. Stress, Personality, and Illness, continued • Stress and other diseases • Life stress has been associated with the following: • Rheumatoid arthritis. • Emergence of lower back pain. • Asthma. • Periodontal disease. • Gastrointestinal disorders.

13. Stress, Personality, and Illness, continued • Stress and immune function • The immune response is “the body’s defensive reaction to invasion by bacteria, viral agents, or other foreign substances”. • A large body of experimental research indicates that stress can impair immune functioning in animals. • Similar immune suppression may also occur in humans.

14. Habits, Lifestyle and Health, continued • As shown in Figure 5.9, unhealthy habits account for the most premature deaths. • Other leading behavioral causes of death include • Alcohol consumption. • Unsafe driving. • Risky sexual behavior. • Illicit drug use.

15. Figure 5.9. Mortality due to health-impairing behaviors. Synthesizing data from many sources, Mokdad and colleagues (2004) estimated the number of annual deaths in the United States attributable to various health-impairing behaviors in an interesting article published in The Journal of the American Medical Association. As you can see, smoking and obesity are the leading causes of preventable mortality. However, their mortality estimate for obesity has proven controversial and is the subject of some debate (some experts argue that their estimate is too high). (Data from Mokdad et al., 2004)

16. Habits, Lifestyle, and Health, continued • Smoking • Health effects associated with smoking include • Greater risk of premature death (13-14 years shorter life expectancy). • Lung cancer, as well as higher risk for many other cancers in the body. • Hypertension, stroke, and other cardiac diseases (see Figure 5.11).

17. Figure 5.11. Health risks associated with smoking. This figure provides an overview of the various diseases that are more common among smokers than nonsmokers. As you can see, tobacco elevates one’s vulnerability to a remarkably diverse array of diseases, including the three leading causes of death in the modern world – heart attack, cancer, and stroke.

18. Habits, Lifestyle, and Health, continued Smoking, continued • Giving up smoking • If people give up smoking, studies show that their health risks decline reasonably quickly, reaching normal levels after about 15 years (see Figure 5.12). • Quitting smoking is difficult, however, and many people fail several times before succeeding.

19. Figure 5.12. Quitting smoking and mortality. Research suggests that various types of health risks associated with smoking decline gradually after people give up tobacco. The data shown here, from the 1990 U.S. Surgeon General’s report on smoking, illustrate the overall effects on mortality rates. The mortality rates on the vertical axis show how much death rates are elevated among smokers and ex-smokers in comparison to nonsmokers. For example, a mortality rate of 3.0 would mean that smokers’ death rate was triple that of nonsmokers. (Data from U.S. Department of Health and Human Services, 1990)

20. Habits, Lifestyle, and Health, continued • Drinking • Why do people drink? • Drinking is widely endorsed in our culture and is viewed as a desirable social ritual. • Drinking dulls negative emotions such as tension, worry, anxiety and depression. • Alcohol makes people feel more relaxed in social settings. • To keep friends and company.

21. Habits, Lifestyle, and Health, continued Drinking, continued • Short-term risks and problems • The “hangover”, which includes headache, dizziness, nausea and vomiting. • Life-threatening overdoses. This is especially problematic when alcohol is mixed with a sedative or narcotic drugs. • Poor judgment, reduced intellectual functioning. • Poor motor coordination. • Increased anger.

22. Habits, Lifestyle, and Health, continued Drinking, continued • Long-term risks and social costs • Alcohol dependence, or alcoholism, is “a chronic, progressive disorder marked by a growing compulsion to drink and impaired control over drinking that will eventually interfere with health and social behavior”. • See Figure 5.16 for a list of serious health problems associated with alcoholism.

23. Figure 5.16. Health risks associated with drinking. This graphic provides an overview of the various diseases that are more common among drinkers than abstainers. As you can see, alcohol elevates one’s vulnerability to a remarkably diverse array of diseases.

24. Habits, Lifestyle, and Health, continued • Overeating • Obesity is a serious risk factor for a number of health problems and diseases (see Figure 5.17).

25. Figure 5.17. Weight and the prevalence of various diseases. This graph shows how obesity, as indexed by BMI, is related to the prevalence of four common types of illness. The prevalence of diabetes, heart disease, muscle pain, and hypertension all increase as BMI goes up. Clearly, obesity is a significant health risk. (Data from Brownell & Wadden, 2000)

26. Habits, Lifestyle, and Health, continued • Overeating, continued • Determinants of obesity: What causes it? • Genetic factors (heredity) account for the majority of cases. • However, environmental factors also contribute: • Excessive eating. • Lack of exercise. • Overabundance of high-calorie food.

27. Habits, Lifestyle, and Health, continued Determinants of obesity, continued • Set point theory “proposes that the body monitors fat-cell levels to keep them (and weight) fairly stable”. • When fat stores get low, we have increased hunger and decreased metabolism, making it difficult to lose weight. • Settling point is an alternative theory that makes more room for long-term benefits of lifestyle changes.

28. Habits, Lifestyle, and Health, continued Overeating, continued • Losing weight • Losing even small amounts of excessive weight can significantly reduce many of the health risks associated with obesity. • Essentially, there are three options: • Sharply decrease food intake. • Sharply increase exercise. • Moderate changes in both diet and exercise (most recommended option).

29. Habits, Lifestyle, and Health, continued • Poor nutrition • Nutrition – “is a collection of processes (mainly food consumption) through which an organism utilizes the materials (nutrients) required for survival and growth.

30. Habits, Lifestyle, and Health, continued Poor nutrition, continued • Nutrition and health • Numerous studies demonstrate a link between patterns of nutrition and health. • Heavy consumption of foods that raise serum cholesterol levels (see Figure 5.18). • Too little fiber and high intake of red meats.

31. Figure 5.18. The link between cholesterol and coronary risk. In a review of several major studies, Stamler et al. (2000) summarize crucial evidence on the association between cholesterol levels and the prevalence of cardiovascular disease. This graph is based on a sample of over 11,000 men who were 18 to 39 at the beginning of the study (1967-1973) when their serum cholesterol level was measured. The data shown here depict participants’ relative risk for coronary heart disease during the ensuing 25 years as a function of their initial cholesterol level. (Data from Stamler et al., 2000)

32. Habits, Lifestyle, and Health, continued Nutrition and health, continued • High salt intake is associated with hypertension. • High caffeine consumption is also associated with hypertension. • High-fat diets • Associated with cardiovascular disease. • May contribute to certain types of cancer.

33. Habits, Lifestyle, and Health, continued Nutrition and health, continued • The basis for poor nutrition • Most nutrition problems are due to • Ignorance (we don’t know what’s really good for us). • Poor motivation (it takes effort to change your diet). • The first steps toward better nutrition are a change in attitude and access to good information.

34. Habits, Lifestyle, and Health, continued Nutrition and health, continued • Nutritional goals • Consume a balanced variety of foods. • Avoid excessive consumption of saturated fats, cholesterol, refined-grain carbohydrates, sugar, and salt. • Increase consumption of polyunsaturated fats, whole-grain carbohydrates, natural sugars, and foods with fiber.

35. Habits, Lifestyle, and Health, continued • Lack of exercise • Benefits of exercise • Enhanced cardiovascular fitness. • Avoidance of obesity. • Decreased risk of colon cancer, and breast and reproductive cancer in women. • Protection from stress. • Positive effect on mental health. • Increase in desirable personality traits.

36. Habits, Lifestyle, and Health, continued Lack of exercise, continued • Devising an exercise program • Choose an activity you enjoy. • Exercise regularly without “overdoing” it. • Increase your participation gradually. • Reinforce yourself for exercising. • It’s never too late to begin!

37. [INSERT VIDEO: Weight Control by Kara Gallagher HERE]

38. Habits, Lifestyle, and Health, continued • Behavior and AIDS • AIDS(acquired immune deficiency syndrome), “a disorder in which the immune system is gradually weakened and disabled by the human immunodeficiency virus (HIV)”.

39. Habits, Lifestyle, and Health, continued Behavior and AIDS, continued • Transmission • HIV is transmitted through contact with bodily fluids (usually blood or semen) and certain behaviors increase risk of contracting HIV: • Not wearing a condom. • Sharing needles. • Anal sex.

40. Habits, Lifestyle, and Health, continued Behavior and AIDS, continued • Misconceptions • HIV can be transmitted through casual contact or by donating blood. • You can have risky sex, with many partners and avoid contracting HIV as long as you do not use IV drugs or have sex with bisexual or gay men. • You can tell if someone is infected by looking at them.

41. Habits, Lifestyle, and Health, continued Behavior and AIDS, continued • Prevention • Have fewer sexual partners. • Wear latex condoms and limit sex acts that allow semen and blood to mix (e.g., anal sex). • Recognize that, despite advances in treatment, HIV is still a life-threatening, serious disease.

42. Reactions to Illness, continued • The decision to seek treatment • People are most likely to seek treatment for an illness if • The symptoms are unfamiliar. • The symptoms appear to be serious, last longer than expected, or disrupt work and social activities. • Family and friends view symptoms as serious and encourage them to get treatment.

43. Reactions to Illness, continued Seeking treatment, continued • The process of seeking treatment has three stages: • We must decide that our physical sensations are symptoms of illness. • We must decide that our symptoms warrant medical care. • We have to arrange for medical care (make an appointment, prepare to pay, etc.).

44. Reactions to Illness, continued Seeking treatment, continued • The biggest obstacle to receiving treatment is procrastination on the part of the patient. • People procrastinate because they • Downplay significance of the symptoms. • Don’t want to look foolish if “it’s nothing”. • Worry about “bothering” their doctor. • Are reluctant to disrupt their plans. • Waste time on trivial matters before going to a hospital emergency room.

45. Reactions to Illness, continued • The sick role • Some people almost seem to enjoy being sick. They have learned that the “sick role” is associated with benefits: • It absolves people from responsibility. • Fewer demands are placed on sick people. • Illness can provide a “face-saving” excuse for failure. • Sick people receive more attention.

46. Reactions to Illness, continued • Communicating with health providers • Good communication with your provider is crucial for good medical care. • Barriers to effective communication: • Medical visits are very brief. • Illness and pain are subjective matters that can be difficult to describe. • Doctors use too much medical jargon – they overestimate the patient’s comprehension of what is being said.

47. Reactions to Illness, continued Barriers to communication, continued • Some providers discourage patients from seeking information. • Patients may be too upset or ill to remember what symptoms to report or which questions to ask. • Patients may withhold information for fear of a more serious diagnosis. • In general, patients are too passive.

48. Reactions to Illness, continued • Adherence to medical advice • Many patients fail to adhere to their physician’s advice (30-50% of the time), and this behavior takes many forms: • Patients fail to begin a treatment regimen. • Patients stop the treatment early. • Patients reduce or increase levels of treatment that were prescribed. • Patients are inconsistent in following treatment procedures.

49. Reactions to Illness, continued Adherence to medical advice, continued: • Factors that affect adherence: • Complexity of the doctor’s orders – patients may not understand or may forget. • How aversive or difficult the treatment is. • Negative attitudes toward a physician. • Whether or not follow-up occurs. This enhances adherence.

50. Application: The Effects of Drugs, continued • Drug-related concepts • “Recreational” drugs usually fall into one of five common categories (see Figure 5.24). • Most drugs produce tolerance effects, or a “decreased responsiveness to a drug with continued use”. • Users may also develop a physical and/or psychological dependence on a drug (see Figure 5.25).