Chapter 7 Physical Disorders and Health Psychology

1. Chapter 7Physical Disorders and Health Psychology

2. 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

3. Figure 7.1 Psychosocial factors directly affect physical health

4. Psychological and Social Factors that Influence Health (continued) • 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

5. 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

6. 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

7. Overview of Stress and the Stress Response (continued) • The Stress Response and the General Adaptation Syndrome • Phase 1 – Alarm response (sympathetic arousal) • Phase 2 – Resistance (mobilized coping and action) • Phase 3 – Exhaustion (chronic stress, permanent damage)

8. 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

9. Physiology of Stress (continued) • 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

10. Psychological and Social Factors: Their Relation to Stress Physiology • 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

11. Psychological and Social Factors: Their Relation to Stress Physiology (continued) • 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

12. Stress and the Immune System • 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

13. Fig. 7.3, p. 269

14. Figure 7.4 Pathways through which psychological factors might influence onset and progression of immune system-mediated disease

15. Stress and the Immune System: The Role of Leukocytes • Leukocytes: Subtypes and Functions • Macrophages • First line of defense, destroy antigens, signal lymphocytes

16. Stress and the Immune System: The Role of Leukocytes (continued) • 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 Dramatically and Quickly Alters Immune Function

17. Acquired Immunodeficiency Virus (AIDS) • Nature of AIDS • 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

18. Acquired Immunodeficiency Virus (AIDS) (continued) • 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

19. 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)

20. Cancer: Psychological and Social Influences • Overwhelming stressful life events • Life-style risk behaviors • Psychological factors also are involved in chemotherapy • Cancer is Influenced by Psychological, Behavioral, and Social Factors

21. 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

22. Cardiovascular Problems: Hypertension (continued) • Contributing Factors and Associated Features • Affects 20% of all adults (between ages of 25 and 74) • 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

23. 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)

24. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued • Ischemia • Deficiency of blood supply because of too much plaque • Myocardial infarction • Heart attack involving death of heart tissue

25. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued • Psychological and Behavioral Risk Factors for CHD • Stress, anxiety, anger, • Poor coping skills • Low social support • Lifestyle factors (e.g., smoking, diet, exercise)

26. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued • Classic Type A Behavior Pattern • Anger and negative affect • Impatience, accelerated speech and motor activity • CHD Is Influenced by Psychological, Behavioral, and Social Factors

27. 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

28. Chronic Pain (continued) • Psychological and Social Factors in Chronic 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 Opiods

29. 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

30. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences (continued) • Speculation About Causes • High-achievement oriented lifestyle • Fast paced lifestyle combines with stress and illness • Psychological misinterpretation of consequences of illness

31. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences (continued) • Treatment • Medications are ineffective • Cognitive-behavioral interventions appear promising

32. 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)

33. Psychosocial Treatment of Physical Disorders (continued) • Comprehensive Stress Reduction and Pain Management Programs • More effective and durable than individual interventions alone

34. Modifying Behaviors to Promote Health • Life-Style Practices – Core of Many Health Problems • Behavioral risk factors are also influenced by psychosocial factors • Prevention and intervention programs target behavioral risks

35. Modifying Behaviors to Promote Health (continued) • Types of Life-Style Behaviors • Injury and injury prevention • Repeated warnings are not enough • AIDS • Highly preventable by changing behaviors • China and smoking cessation programs • Diet, exercise, promotion of health and wellness • Stanford three community study

36. 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

37. Summary (continued) • Risk for Physical Illness • Related to long-standing patterns of behavior & life-style factors • Psychosocial Treatments • Aim to prevent and/or treat physical disorders • Comprehensive individual or community programs are best

38. Summary of Physical Disordersand Health Psychology (cont.) Figure 9.x1 (cont.) Exploring physical disorders and health psychology

39. Summary of Physical Disordersand Health Psychology (cont.) Figure 9.x1 (cont.) Exploring physical disorders and health psychology

40. Summary of Physical Disordersand Health Psychology (cont.) Figure 9.x2 Exploring treatments for physical disorders

41. Summary of Physical Disordersand Health Psychology (cont.) Figure 9.x2 (cont.) Exploring treatments for physical disorders

42. Summary of Physical Disordersand Health Psychology (cont.) Figure 9.x2 (cont.) Exploring treatments for physical disorders

43. Web Sites • Society for Behavioral Medicine • www.sbmweb.org • Health Psychology and Rehabilitation • www.healthpsych.com • High Blood Pressure • www.nhlbi.nih.gov/hbp/index.html • American Psychological Association • www.apa.org