Physical Disorders and Health Psychology

1. Physical Disorders and Health Psychology

2. Psychological and Social Influences on Health • Top fatal diseases no longer infectious • Psychology and behavior contribute to top fatal diseases • 50% of deaths from 10 leading causes of death in US can be linked to behavior

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. Stress and the Immune System • Early research on stress and cold viruses • Stress • Negative affect • sociability • Psychological impact on immune functioning

7. Stress and the Immune System Psychology Immune System Illness

8. Stress Relationship problems Job loss Death of a loved one Depression Lack of social support Chronic stress Providing care for others Factors Contributing to Immune Functioning

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

10. 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 HIV -> AIDS 7.3-10 years • Multiple medications • 61% of patients discontinue due to side effects

11. Psychology & AIDS • Stress of diagnosis • Stress management interventions = • less anxiety • Less depression • Increased immune function • Less disease progression @ 2 year follow-up • High stress & low social support related to faster disease progression

12. Psychology & AIDS • Ongoing stress • 10-week CBT can buffer increased viral load • Viral load predicts onset of full AIDS • Mixed findings • Unclear source of effectiveness • Increase control • Decrease hopelessness • Coping • Negative thoughts • Social support

13. Cancer (Psychoncology) • Psychological influences on development and course • Early research prolonged survival with therapy for metastasized breast cancer • 2 times as long as controls • at 4 years, 1/3rd tx group alive, no controls • At 10 years, 3 patients in tx group alive

14. 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

15. Cardiovascular Problems - Hypertension • Blood vessels constrict, heart works harder (wear and tear) • Risk for stroke, heart disease, kidney disease • Symptoms can be invisible • High association with early mortality • 27% of individuals 35-64

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

17. Coronary Heart Disease • Blockage of arteries supplying blood to heart • Stress • Anxiety • Anger • Poor coping • Low social support • Type A behavior pattern • 2x likely to develop CHD (longitudinally)

18. 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

19. Coronary Heart Disease • Time urgency also important • Anxiety/depression • Depression = 3x likely death after heart attack • Stress-reduction programs yield 34% reduction in death from heart attack

20. 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

21. 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

22. Psychosocial Treatments for Physical Disorders

23. Psychosocial Treatment for Physical Disorders • Stress management often component in medical treatment • Biofeedback • Relaxation & Meditation • Comprehensive Stress & Pain Reduction Program • Denial as Coping

24. 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

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

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

27. 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

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

29. Denial as a Means of Coping • Denial might not always be bad • Initial denial of seriousness can be helpful • Better endurance of initial shock • Decreased time in ICU • Negative effects post-discharge • Less physiological stress-related markers

30. Modifying Behaviors to Promote Health • Remember psychological factors influence health in 2 ways: • Direct effect on biological processes • Risky health behavior

31. Modifying Behaviors to Promote Health • 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