no class on thursday feb. 13. 1. counterproductive coping a. isolation b. negative beliefs 2. social...
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NO CLASS ON THURSDAY FEB. 13
1. Counterproductive copinga. Isolationb. Negative beliefs
2. Social Support: a. Hazards of positive supportb. Hazards of no support
3. Negative stereotypes
4. Medical complications and risks
5. Double binds (1-4, above)
Psycho-social Complications of Chronic Pain
Wrong model:
Pain Depression --- What’s missing?
Correct model:
Pain ↓ activity ↓ mastery ↓ control Depression
Pain and Depression
Pain Prone Personality
Are some personalities more prone to experiencing, reporting pain?
MMPI = Minnesota Multiphasic Personality Inventory
a. Acute pain pats: Hypochondriasis – overly attend to body Hysteria – extreme emotionality/exaggerate symps.
b. Chronic pain pats: Neurotic triad: Hypcondriasis + hysteria + depression
Secondary gain: What are social benefits of pain? Attention, special identity“Functional type”: neurotic triad + schizo / psychopathology / paranoia
Danger of “Pain Prone Personality” concept?
1. Negative stereotypes 2. Causal direction
Drugs
Surgery
Sensory Control: Counter-irritation
“MECHANICAL” PAIN REDUCTION TECHNIQUES
BiofeedbackRelaxationHypnosisAcupunctureGuided ImageryCognitive ReframingDistractionPain Management Programs
“PSYCHOSOCIAL” PAIN REDUCTION TECHNIQUES
Pain Relief Through Virtual RealitySevere burns one of most painful conditions to treat: cleaning, re-bandaging excruciating.
Pennebaker symptom research suggests that distraction should do what to pain?
Reduce it. Why? Competition of cues.
SnowWorld: Virtual Reality program designed for pain relief.
Patients enter SnowWorld during procedures
Shoot snowballs at snowmen, penguins
Report pain reductions 30%-50%
Note SnowWorld colors. Why?
Summary Benefits of Psychosocial Approaches
Change meaning of experience
Provides skill set, reduces helplessness
Gives patients an active role in pain management
Success with techniques increases self-efficacy
Changes ways of thinking
1. Evaluationa. pain b. functional status: life style changes, limitationsc. Emotional and mental functioning
2. Treatment plana. Pre-set time. Not indefinite.b. Specific goals.c. Contract
3. Programa. Education
1. Nature of pain: physio, psychological2. Pain reduction techniques
b. Therapy1. Psycho therapy2. Cognitive therapy:
c. Family therapyd. Relapse prevention
Pain Management Programs
Class 7: Stress I
Stress: Health Psych
“Bullseye”
Integrates mental states, bodily states, environmental conditions
Window to core psych processes:
* How we make sense of events, and how interpretations affect health.
• Emotions, emotions & thinking, emotional control• Social relations in coping and in failed coping
Stress is where psych can do most for health.Causes of illness, Treatment of illness, illness prevention
What Are Stressful Events?
Broken Heart Syndrome
Temporary heart condition due to loss-related stressChest pain, due to surge of stress hormones.
Loss-related stress? Break-upDeathDeparture
“Stress cardiomyopathy”
Duration: typically 1 week
Stress is a negative emotional experience accompanied by
predictable biochemical, physiological, cognitive, and behavioral
changes that are directed either toward altering the stressful
event or accommodating to its effects. Taylor, p 168.
Stress Defined
Cannon Model of StressWalter Cannon, 1932
Fight or Flight response
SNS + endocrine mobilizes body for fight or flight
Stressful events
_____You can fight: .....
_____You can flee ...
_____You can neither fight nor flee, "traps"
Which are the most stressful?
X
General Adaptation Syndrome (GAS)
Hans Selye (1956)All stressors produce same pattern:
Enlarged adrenals
Shrunken thymus
Shrunken lymph
Ulcerated stomach
Per Selye: Prolonged stress -->
cardiovascular disease
arthritis
hypertension
compromised immune system
1. SAM: Sympathetic-adrenomedullary
Event cortex hypothalamus SNS adrenal medulla catecholamines charged feeling increased BP, HR, etc.
SAM Corresponds to Cannon's stress model
2. HPA: Hypothlamic-pituitary-adreocortical
Event cortex hypothalamus coritcotrophin releasing factor (CRF) pituitary adrencorticotropic hormone (ACTH) adrenal cortex
corticosteriods conserves carbos reduces inflammation
HPA corresponds to Selye's stress model
Physiology of Stress
SAM and HPTA Stress Patterns
Health Implications of Sustained StressCatecholamine elevation, sustained, inhibits immune system
Cardiovascular effects
1. Arteriosclerosis
2. Senility: neurons in hippocampus
3. Depression
4. Fat distribution: Higher waist-to-hip ratio
5. Sudden death syndrome
Stress, Opioids, and Illness Susceptibility
Opiates are? Pain-reducing drugs, from plants. Morphine, heroin
Endogenous opiods (aka endorphines): Like opiate, produced by body.
Stress triggers endorphine production
Stress opioid release immune suppression ? ↑ illness susceptibility
Prolonged Stress Widens “Window of Vulnerability”
Chronic stress ↑ recovery phase ↑ cortisol phase
↑ immune suppression ↑ illness risk.
Allostatic load = effects of cumulative stress exposure
Reactivity and Stress Vulnerability
People vary in stress reactions
NOT just a matter of being mentally tough / whimpy
Physical constitutions differ
Autonomic NSNeuroendocrine response Immune response
Study of children 3-5 yrs old, reactivityMeasure reactivity to stressor -- a. cardio (HR, BP) b. immuneParents track stressor reactions, illness for 12 weeks Result: stress leads to illness among
____ Low Reactive ____ High Reactive
X
Stress as Function of Person-Environment Fit
Low Stress: Resources >> ChallengeModerate Stress: Resources ≥ ChallengeHigh Stress: Resources < Challenge