Physical Disorders and Health Psychology

1. Physical Disorders and Health Psychology

2. Psychological and Social Influences on Health • Contribute to top fatal diseases • 50% of deaths from 10 leading causes of death in US can be linked to behavior

3. Behavioral medicine • Prevention, diagnosis, treatment • Interdisciplinary • Health psychology • Psychological factors important in promotion, maintenance of health • Health care policy

4. Affect basic biological process that lead to illness E.g stress and cardiovascular health Influence risky behavior Smoking Alcohol Nutrition Ways Psychology Influences Health

6. Selye’s General Adaptation Syndrome • Body’s response to sustainedstress • Alarm • Resistance • Exhaustion

7. Stress and the Immune System • Early research on stress and cold viruses • Psychological impact on immune functioning • Depression has a direct effect? • Self care and risky behaviors

8. Psychological Effects on Physical Disorders • AIDS • Cancer • Cardiovascular Problems • Hypertension • Coronary Heart Disease • Chronic Pain • Chronic Fatigue Syndrome

9. AIDS • 40 million worldwide live with AIDS (2003) • 20-40% of pop’n in southern Africa • Course variable • Up to years with no or minor symptoms • Median time to full-blown AIDS 7.3-10 years • Up to 15% live 5 years or longer • Multiple medications • 61% of patients discontinue due to side effects

10. AIDS • Stress of diagnosis • Stress management interventions = less anxiety and depression and increased immune fx • Less disease progression 2 year follow-up • Ongoing stress • CBT can buffer increased viral load • Viral load predicts onset of full AIDS

11. Cancer (Psychoncology) • Psychological influences on development and course • Early research prolonged survival with therapy (Spiegel) • 2 times as long as controls • at 4 years, 1/3rd tx group alive, no controls • Ease of intervention

12. Cancer • How do psychological interventions work? • Better health habits • Closer adherence to treatment • Improved endocrine functioning • Better response to stress • Improved immune functioning • Enhanced social adjustment • Better coping

13. Cancer • Psychological preparation for children

14. Cardiovascular Problems - Hypertension • Risk for stroke, heart disease, kidney disease • Symptoms can be invisible • High association with early mortality • Blood vessels constrict, heart works harder (wear and tear)

15. Psychological Influences on Hypertension • personality • Coping style • stress levels • Social support • Loneliness, depression • Hostility • Time urgency

16. Coronary Heart Disease • Stress, anxiety, anger • Poor coping • Low social support • Stress-reduction programs yield 34% reduction in death from heart attack • Type A behavior pattern • 2x likely to develop CHD (longitudinally)

17. Coronary Heart Disease and Chronic Negative Emotions • Mixed findings Type A • Measurement • Some components, not others • Anger responsible for much of effect • Impairs pumping efficiency in lab • Associated with artery calcification • Time urgency also important • Anxiety/depression • Depression = 3x likely death after heart attack

18. Chronic Pain • Pain as beneficial, motivational • $125 billion annually is spent on chronic pain • 80% of doctor’s visits due to pain • Acute pain • Chronic pain

19. Psychological and Social Aspects of Pain • Severity of pain does not predict reaction • What impacts reaction? • Sense of control • Can I deal with the pain and it’s consequences? • Positive control = less distress, disability • Increase concrete coping (e.g., exercise) • Depression, anxiety, social support

20. Biological Aspects of Pain • Gate Control Theory • Nerve impulses from stimuli, to spine, to brain • Dorsal horns of spinal column = gate • If stimuli intense, gate open and pain signal sent • Brain will send signals back to spinal cord, impacting gate • Inhibitory or excitatory messages

21. Biological Aspects of Pain • Endogenous opiods • Shut down pain • In presence of injury or tissue damage • Sense of control can increase endogenous opiods

22. Chronic Fatigue Syndrome • Lack of energy • Marked fatigue • Aches and pains • Low-grade fever • No physical pathology was found • Neurasthenia (“lack of nerve strength”)

23. Medically unexplained fatigue of at least 6 months Of new onset Not from exertion Not alleviated by rest Reduction in previous activity level 4 or more of: Subjective memory impairment Sore throat Tender lymph nodes muscle pain Joint pain Headache Unrefreshing sleep Postexertional malaise Symptoms of Chronic Fatigue Syndrome

24. Chronic Fatigue Syndrome • Often substantial disability • Unsure of cause • Viruses • Immune system dysfunction • Depression • Toxins • Nonspecific response to stress • CBT seems relatively effective

25. Psychosocial Treatment for Physical Disorders • In animal models, pain can = death • Stress management often component in medical treatment • Biofeedback • Relaxation & Meditation • Comprehensive Stress & Pain Reduction Program • Denial as Coping

26. Biofeedback • Patients aware of own bodily functions • Blood pressure • Brain waves • Heart rate • Muscle tension • 1960s Miller - rats learn to control responses • Physiological monitoring makes response visible

27. Biofeedback • Work with therapist to change response • Success = signal • People can control with good accuracy

28. Relaxation and Meditation • Progressive muscle relaxation • Used in conjuction with other interventions • Meditation • Transcendental meditation (Focus on mantra) • Mindfulness meditation

29. Denial as a Means of Coping • Optimism can speed recovery • Rapid return to normal activities • Better quality of life • Less likely to use denial • Denial • Avoid treatment • Not notice changes

30. Denial as a Means of Coping • Initial denial of seriousness can be helpful • Better endurance shock • Decreased time in ICU

31. Modifying Behaviors to Promote Health • Remember psychological factors influence health in 2 ways: • Direct effect on biological processes • Risky health behavior • Four areas of interest: • Injury Prevention • AIDS Prevention • Smoking • Stanford Community Study

32. Injury Prevention • Leading cause of death aged 1-45 • High loss of productivity • Prevention in children • Escaping fire • Reporting emergencies • Crossing the street

33. AIDS Prevention • Changing behavior only effective prevention • Testing does not necessarily change behavior • Targeting risky behavioral effective • Increase self-efficacy & control

34. Comprehensive Stress- and Pain-Reduction Program • Components of stress management • Monitor stress and identify stressful events • Deep muscle relaxation • Appraisals of events • Importance • Impact • Time management • Assertiveness training • Better than individual components