Physical Disorder and Health Psychology

1. Physical Disorder and Health Psychology De’Aona Lewis, Lolita Ramsey, Shacora Davis, Victoria Williams, Taylor Moore, Manuel Lewis

2. Psychological and Social Factors that Influence Health • United States surgeon general • Diseases Rates • Genital Herpes • HSV I-II

3. Health and Health Related Behavior • Second revolution • Two fields of Studies • Behavioral • Health Psychology • Psychological and Social Factors • AIDS • Other behavior patterns

4. The Nature of Stress • Hans Selye • Montreal, Canada • Rat Experiment in 1936 • Stress Physiology • Stages of Sustained Stress • Alarm • Resistance • Exhaustion

5. The Physiology of Stress • Chapter 2- the physiological effects of the early stages of stress • HPA • Neuromodulators and Neurotransmitters • Stress Hormones

6. Contributions to Stress Response • Stress physiology is profoundly influence by psychological and social factors. • Sapolsky- Stress in baboons • Cortisol • Sense of control

7. Stress, Anxiety, Depression, and Excitement

8. Stress and the Immune System • Increase in stress= Increase of infections • Cohen and colleagues (1995) • Cohen, Doyle, Turner, Alper and Skoner • Exam periods are stressors that have been shown to produce increased infections • Stress weakens the immune system • Stressful events lead to lowered immune system functioning. • Studies show as early as 2 hours

9. Stress and the Immune System (cont.) • Stress hormones trigger cytokine interleukin 6 • Depression also lowers immune system functioing • Chronic stress may be more problematic than an acute or sudden stressor. How the Immune System Work • Antigens- foreign materials • Immune system contains 2 major parts • Humoral • Cellular

10. AIDS • The ravages of the aids epidemic have made this disease the highest priority of our public health system. • Once a person is infected with HIV, the course of the disease is quite variable. • ACR aid related complex is a group of minor health problems such as weight loss, fever, and night sweats that appear after HIV infection but before development of full blown aids. • Since AIDS is a relatively new disease, with a ling latency to development, we are still learning about the factors, including possible psychological factors, that extend survival.

11. Psychosocial Effects on Physical Disorder

12. CANCER • Among the more mind-boggling developments in the study of illness and disease is the discovery that the development and course of different varieties of cancer are subject to psychosocial influences. • Psychoncology is the study of cancer. • Psychological factors are also prominent in treatment and recovery from cancer in children. Many types of cancer require invasive and painful medical procedures. • Psychological preparation reduces suffering and facilitates recovery in children who undergo surgery.

13. CARDIOVASCULAR PROBLEMS • The cardiovascular system comprises the heart, blood vessels, and complex control mechanisms for regulating their function. May things can go wrong with this system and lead to cardiovascular disease. • Many individuals, particularly older individuals, suffer strokes, also called cerebral vascular accidents (CVAs), which are temporary blockages of blood vessels leading to the brain or a rupture of blood vessels in the brain that results in temporary or permanent brain damage and loss of functioning.

14. HYPERTENSION SLIDES • Hypertension ( high blood pressure ) is a major risk factor not for stroke and heart disease but also for kidney disease. • Essential hypertension is high blood pressure with no verifiable physical cause, which makes up the overwhelming majority of high blood pressure cases. • Psychological factors, such as personality, coping style, and again, level of stress, have been used to explain individual differences in blood pressure

15. Coronary Heart Disease

16. What Is It? • Coronary Heart Disease (CHD) is a blockage of the arteries supplying blood to the heart muscle (myocardium).

17. Terms • Angina pectoris/angina-chest pain resulting from partial obstruction of the arteries. • Atherosclerosis-occurs when a fatty substance or plaque builds up inside the arteries and causes an obstruction. • Ischemia-the name for the deficiency of blood to a body part caused by the narrowing of the arteries by too much plaque • Myocardial infaction/heart attack-the death of a heart tissue when a specific artery becomes clogged with plaque. Arteries can constrict or become blocked for a variety of reasons other than plaque. for example, a blood clot might lodge in the artery.

18. What Sort of Psychological Factors Contribute? • A variety of studies strongly suggest that stress, anxiety, and anger combined with poor coping skills, and low social support are implicated in CHD. • Severe stress as in learning that a family member suddenly died, can lead on rare occasions to a condition called myocardial stunning, which is basically heart failure. • Some studies indicate that even healthy men who experience stress are later more likely to experience CHD than low stress groups. for such individuals, stress reduction procedures may prove to be an important preventive technique.

19. Report/Study • -In one report summarizing results from 37 studies, and using analytic procedures that combine the results from these studies (meta-analysis), the effects of stress reduction programs on CHD were quite apparent. These studies yielded a 34% reduction in death from heart attacks, a 29% reduction in the recurrence of heart attacks and a significant positive effect on blood pressure, cholesterol levels, body weight and other risk factors for CHD. • A more recent major clinical study confirmed the benefits of stress reduction and exercise in reducing emotional distress and improving heart function and risk for future attacks in a group of individuals with established heart disease.

20. Can We Identify CHD Early? • Can we identify before an attack people who are under a great deal of stress that might make them susceptible to a first heart attack? YES • -Clinical investigators reported several decades ago that certain groups of people engage in a cluster of behaviors in stressful situations that seem to put them at a considerable risk for CHD.

21. Behaviors • Meyer Friedman & Ray Rosenman • Excessive competitive drive, a sense of always being pressured for time, impatience, incredible amounts of energy that may show up in accelerated speech and motor activity, and angry outbursts. • Type A Behavior Pattern • Type B Behavior Pattern • applies to people who do not have type A attributes. The type B individual is more relaxed, less concerned about deadlines, and seldom feels the pressure or perhaps the excitement of challenges or overriding ambition.

22. Two Specific Studies WESTERN COLLABORATIVE GROUP • In this project 3,154 healthy men age 39-59 were interviewed at the beginning of the study to determine their typical behavior patterns. They were then followed for 8 years. The basic finding was that men who displayed a type A behavior pattern at the beginning of the study were at least twice as likely to develop CHD as the men with type B behavior pattern. when the investigators analyzed the data for the younger men in the study age 39-49, the results were even more striking, with CHD developing approximately 6 times more often in the type A group than B group. FARMINGHAM HEART STUDY This study has been ongoing for more than 40 years and has taught us much of what we know about the development and course of CHD. In this study 1,674 healthy men and women were categorized by a type A or type B behavior pattern and followed for 8 years. Again both men and women with a type A pattern were more than twice as likely to develop CHD as their type B counterparts (in men, the risk was nearly 3 times as great). For women those results were strongest for those with a low level of education.

23. Difficulties • It is difficult to determine whether someone is type A from structured interviews, questionnaires, or other measures of this construct, because the measures often do not agree with one another. Many people have some characteristics of type A but not all of them, and others present with a mixture of types A and B. the notion that we can divide the world into two types of people has been discarded and as a result subsequent studies did not necessarily support the relationship of type A behavior to CHD.

24. CHRONIC PAIN

25. What Is Pain? • Pain is not in itself a disorder, yet for most of us it is the fundamental signal of injury, illness or disease. The importance of pain in our lives cannot be underestimated. Without low levels of pain providing feedback on the functioning of the body and its various systems, we would incur substantially more injuries. For example, you might lie out in the hot sun a lot longer and be badly burned. You might not roll over while sleeping or shift your posture while sitting thereby affecting your circulation in a way that might be harmful. Reactions to this kind of pain are mostly automatic; that is, we are not aware of the discomfort. • When pain crosses the threshold of awareness, which varies a great deal from one person to another, we are forced to take action. If we cant relieve the pain ourselves or we are not sure of its cause, we usually seek medical help.

26. Acute vs Chronic Pain • Acute and chronic pain are types of clinical pain. • Acute pain typically follows an injury and disappears once the injury heals or is effectively treated, often within a month. • Chronic pain may begin with an acute episode but does not decrease over time, even when the injury has healed or effective treatments have been administered. It is typically in the muscles, joints or tendons, particularly in the lower back • Pain, Pain behaviors, Suffering • The severity of pain does not seem to predict the reaction to it.

27. Psychological and Social Factors • Psychological factors • When a positive sense of control is combined with a generally optimistic outlook about the future, there is substantially less distress and disability. • Philips and Grant (1991) • Gatchel, Polatin, and Kinney (1995) • Zatura and Colleagues (2005)phantom limb pain • Social Factors • -Family • -Operant Control of pain behavior • Jamison and Virts (1990) • General social support may reduce the stress associated with pain and injury and promote more adaptive coping procedures and control. However specifically reinforcing pain behaviors, particularly in the absence of social supports, may powerfully increase such behavior. These complex issues have not yet been entirely sorted out.

28. Biological Aspects • Gate Control Theory of Pain Nerve impulses from painful stimuli make their way to the spinal column and from there to the brain. An area called the dorsal horns of the spinal column acts as a “gate” and may open and transmit sensations of pain if the stimulation is sufficiently intense. Specific nerve fibers referred to as small fibers (A-delta and C fibers) and large fibers (A-beta fibers) determine the pattern as well as the intensity of the stimulation. Small fibers tend to open the gate, thereby increasing the transmission of painful stimuli, whereas large fibers tend to close the gate. Most important for our purpose is that the brain sends signals back down the spinal cord that may affect the gating mechanism. • Endogenous Opioids The neurochemical means by which the brain inhibits pain is an important discovery. -Heroin, Morphine -Endogenous Opioids exist within the body (enkephalins, endorphins) and act much lik neurotransmitters. The brain uses them to shut down pain, even in the presence of marked tissue damage or injury. -Psychopathological Conditions • Gender Differences -Females (menstrual cramps, labor pains, migraine headaches, arthritis, carpal tunnel syndrome, and temporomandibular joint (TMJ) pain in the jaw. -Males have more cardiac pain and backache. Endogenous Opioid systems are more powerful in males.

29. CHRONIC FATIGUE SYNDROME

30. Definition • Inclusion Criteria 1. Clinically evaluated, medically unexplained fatigue of at least 6 months duration that is • Of new onset (not lifelong) • Not resulting from ongoing exertion • Not substantially alleviated by rest • A substantial reduction in previous level of activities 2. The occurrence of four or more of the following symptoms: • Subjective memory impairment • Sore throat • Tender lymph nodes • Muscle pain • Joint pain • Headache • Unrefreshing sleep • Postexertional malaise lasting more than 24 hours

31. Complex Specific Model Core beliefs -I am inadequate Beliefs I must always perform perfectly I must always cope I must never show weakness Depression is evidence of weakness Lifestyle Achievement oriented and hard-working Puts on a brave face Doesn’t ask for help Trigger (stress or acute illness) Symptoms -fatigue -muscle pain -other symptoms -unable to function Thoughts -I must be physically ill -I’m making myself worse -there’s nothing I can do -I should try harder to cope -I can beat this Mood -distressed -frustrated Behavior -extreme rest and avoidance of activity -seeks medical care -puts a brave face on things -episodic bursts of activity Physiology -effects of inactivity and emotional distress -other processes (?)

32. Psychosocial Treatment of Physical Disorders • Biofeedback  • Relaxation and Meditation  • A Comprehensive stress and Pain-Reduction Program Psychosocial Treatment of Physical Disorders • John Liesbeskind and rat experiment • Postsurgical pain in rats doubles as cancer metastasizes to the lungs.

33. Biofeedback • The process of making patients aware of specific physiological functions that ordinarily, they would not notice consciously. • Ex: heart rate, blood pressure, muscle tension in specific areas of the body, electroencephalogram rhythms, and patterns of blood flow. • Edward Blanchard-a pioneer in the development and testing of biofeedback. • 1960 Neal Miller and Conscious Awareness • Humans discriminate changes in autonomic nervous system activity but poorly discriminate their internal states.

34. Biofeedback (Cont.) • Zillmann(1983) • Shapiro (1974) • A goal of biofeedback has been reducing tension in the muscles of the head and scalp which helps relieve headaches. • Holroyd(1984) says these procedures instill a sense of control over the pain.

35. Relaxation and meditation • Progressive muscle relaxation – patients become aware of tension in body and relax specific body muscle groups. • Transcendental meditation – attention is focused on a repeated syllable or mantra. • Herbert Benson (relaxation response) developed procedure in which a person silently repeats mantra to minimize distractions by closing mind to intruding thoughts.

36. Relaxation and meditation (cont.) • Meditation for 10 to 20 minutes was reported to make people calmer or more relaxed throughout the day. • Procedures reduce flow of certain neurotransmitters and stress hormones. • Bensons ideas are taught in 60% of the U.S. medical schools. Also offered by many hospitals.

37. A comprehensive stress & Pain-reduction program • Individuals practice a variety of stress management procedures. • Daily stress is recorded specifically. • Times of experienced stress • Intensity of stress • What triggers stress • Clients taught to tense muscles then to actively let go of muscles so no tension remains.

38. Break down of Pain reduction • Appraisals and Attitudes (Cognitive Therapy) • During Program –individuals work to Identify unrealistic thoughts and develops new appraisals and attitudes instantly when negative thoughts occur. • Time management training – prioritize activities and pay less attention to nonessential demands. • Assertiveness training – clients learn to stand up for themselves in an appropriate manner.

39. Drugs and Stress Reduction Program • There is a enormous nationwide reliance on over-the-counter medications for pain • Evidence shows that chronic reliance on pain medication lessens the effectiveness of comprehensive programs for treatment (Capobianco, Swanson,&Dodick, 2001) • Actually increases headache pain every time

40. Denial as means of Coping • People that are optimistic recover more quickly (Scheier et. al 1989) • Individuals who regularly used denial, avoidance, and wishful thinking had higher level of anxiety and somatic complaints. • Mental health professionals work to eliminate denial because it has many negative effects

41. Denial as means of Coping (cont.) Denial is not always harmful • Shelly Taylor ( 2006) showed that denial can benefit people in the beginning of a serious condition. • However at some point we must face the situation , process our emotions, and come to terms what is happening.

42. Modifying Behavior to Promote Health In 1991 U.S Department of Health and Human Services said “Our research is teaching us that many common diseases can be prevented and others can be postponed or controlled simply by making possible lifestyle changes”

43. Modifying Behavior to Promote Health (cont.) Injury Prevention • Accidents are the leading cause of death for people aged 1 to 45 • 5th leading cause of death in the United States Modifying behaviors to prevents theses accidents • Fire prevents, fire escape drills • Safely crossing streets • Learning First Aid • Bicycles safety

44. Modifying Behavior to Promote Health (cont.) AIDS Prevention • Changing high-risk behavior is the only effective prevention strategy • Training selective people from different communities to do their own outreach along with media coverage is more effective. Modifying behaviors to prevents theses accidents • HIV classes • Outreach material • Teaching the mode of transmission • Teaching safe ways to have sex