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. 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

4. 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

5. 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

6. 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)

7. Physiology of Stress • The Biology of Stress • Activates the sympathetic branch of the ANS • Activates the HPA axis, producing cortisol

8. 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

9. 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

10. 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

11. 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

12. Fig. 7.3, p. 269

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

14. 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

15. 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

16. 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

17. 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)

18. 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

19. 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

20. 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

21. 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)

22. 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

23. 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)

24. 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

25. 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

26. 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

27. 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

28. 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

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

30. 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)

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

32. 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

33. 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

34. 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

35. 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