Chapter 9 Physical Disorders and Health Psychology

1. Chapter 9Physical Disorders and Health Psychology

2. Physical Disorders and Health: An Overview Psychological, Behavioral, and Social Factors Major contributors to medical illness and disease Examples include genital herpes, AIDS, cancer, cardiovascular diseases Psychological Approaches to Health and Disease Behavioral medicine � Prevention, diagnosis, treatment of medical illness Health psychology � Psychological factors in promotion of health DSM-IV and Physical Disorders Coded on Axis III Psychological factors can affect medical conditions

3. How Do Psychological and SocialFactors Influence Medical Illness? Two Primary Paths Psychological factors can influence biological processes Behavior patterns may put people at risk for disease AIDS is an example of both forms of influence 50% of the Leading Causes of Death in the U.S. Are linked to behavioral / lifestyle patterns

4. Overview of Stress and the Stress Response Nature of Stress Stress � Physiological response of an individual Stressor � Event that evokes the stress response Stress responses vary from person to person 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)

5. The Biology of Stress Stress activates the sympathetic nervous system Neuromodulators & neuropeptides � Like neurotransmitters Stress activates the HPA axis, producing cortisol The relation between the hippocampus and HPA activation Function of the Hippocampus in HPA-Stress Response Cycle Hippocampus � Limbic system, responsive to cortisol Hippocampus helps to turn off the HPA cycle Chronic stress may damage cells in the hippocampus Hippocampal cell damage can keep the HPA loop going The Biology of Stress

6. 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 status � Fewer lymphocytes and weak immune system High status � Benefit from stability and controllability Psychosocial Vulnerabilities Contribute to Physical Illness Stress, perceived uncontrollability, low social support, negative affect Interpretation of Physiological Response and Situation Seems Critical Self-efficacy

7. The Immune System: Overview and Its Functions Divisions of the Immune System Humoral branch � Blood and other bodily fluids Cellular branch � Protects against viral / parasitic infections Function of the Immune System Identify and eliminate antigens (i.e., foreign materials) Leukocytes are the primary agents

8. Figure 9.5 An overview of the immune system.

9. Leukocytes: Subtypes and Functions Macrophages � First line of defense, destroy antigens, signal lymphocytes Lymphocytes � B cells (humoral branch ) and T cells (cellular branch) B cells produce antibodies, but T cells do not Functional role of B cells, T cells, and memory cells Stress Dramatically and Quickly Alters Immune Function The Immune System: Overview and Its Functions (cont.)

10. Acquired Immunodeficiency Virus (AIDS) Nature of AIDS Course from HIV to full blown AIDS is variable Median time from infection to AIDS is 7.3 to 10 years Most die within 1 year of diagnosis 15% of AIDS patients survive 5 years or longer Stress of getting an AIDS diagnosis can be devastating Role of Stress Reduction Programs High stress and low social support speed AIDS progression Goals � Reduce stress, improve immune system function Psychological, Behavioral, and Social Factors Influence AIDS

11. 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 / inappropriate coping responses (e.g., denial) Overwhelming stressful life events Life-style risk behaviors Psychological factors are also involved in chemotherapy Influenced by Psychological, Behavioral, and Social Factors

12. Cardiovascular Diseases: Hypertension Cardiovascular Disease Heart, blood vessels, and related regulatory mechanisms Hypertension � High Blood Pressure Major risk factor � Stroke, heart disease, and kidney disease Causes wear and tear of the blood vessels Essential hypertension is the most common

13. Associated Features of Hypertension Affects 26.7% of all adults between the ages of 35 and 64 African Americans are at greatest risk Salt, fluid volume, sympathetic arousal, stress level Expressed anger and hostility Influenced by Psychological, Behavioral, and Social Factors Cardiovascular Diseases: Hypertension (cont.)

14. Coronary Heart Disease (CHD) Blockage of arteries supplying blood to the heart muscle Angina pectoris � Chest pain from partial obstruction Atherosclerosis � Artery plaque (i.e., fatty substances) Ischemia � Deficiency of blood supply (too much plaque) Myocardial infarction � Heart attack, death of heart tissue Cardiovascular Diseases: Coronary Heart Disease (CHD)

15. Psychological and Behavioral Risk Factors for CHD Stress, anxiety, anger Poor coping skills, low social support Type A Behavior Pattern Anger and negative affect Impatience, accelerated speech and motor activity Psychological, Behavioral, and Social Factors Influence CHD Cardiovascular Diseases: Coronary Heart Disease (CHD)

16. Pain: Psychological and Social Influences Acute vs. Chronic Pain Acute � Disappears within 1 month Chronic � Does not decrease over time Severity of pain does not predict one�s reaction to it Some Clinical Distinctions Pain vs. pain behaviors 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 Endogenous Opioids Gender Differences

17. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences Nature of Chronic Fatigue (CF) Lack of energy, marked fatigue, pain, and low-grade fever Most common in females Incidence increasing in Western countries Unrelated with viral infection, immune problems, depression Speculation About Causes CF seems related to a high-achievement oriented lifestyle Fast paced lifestyle combines with stress and illness Psychological misinterpretation of after effects of illness Treatment Medications are ineffective Cognitive-behavioral interventions appear promising

18. Psychological Treatment of Physical Disorders Biofeedback: An Overview Patient learns to control bodily responses Used with chronic headache and hypertension Overview of Relaxation and Stress Management Procedures Progressive muscle relaxation Autogenic relaxation training Transcendental meditation (TM) Comprehensive Stress and Pain Management Programs More effective and durable than individual interventions

19. Stressful Heart

20. Modifying Behaviors to Promote Health Life-Style Practices Many health problems are linked to lifestyle and behavior Behavioral risk factors are influenced by psychosocial factors Prevention and intervention programs target behavioral risks Types of Life-Style Behaviors 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

21. Psychological Factors Play a Major Role in Physical Disorders Behavioral medicine and health psychology Psychosocial Factors: Their Role in Illness and Disease Stress, immune function, and disease Such influences interact with psychosocial factors 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 Summary of Physical Disorders and Health Psychology

22. Exploring Physical Disorders

23. Exploring Physical Disorders (cont.)

24. Exploring Physical Disorders (cont.)

25. Exploring Physical Disorders (cont.)

26. Exploring Physical Disorders (cont.)