physical disorders and health psychology chapter seven
TRANSCRIPT
Physical Disorders and Health Psychology
Chapter seven
Some terms..
• Behavioral medicine• Applying behavioral sciences to
prevention, diagnosis and treatment of medical problems
• Health psychology• Psychological factors in the health and
wellness, including health care systems and health care policies
Biopsychosocial approach
• Psychological and social factors lead to illness and disease
• Long-standing behavior problems may put people at risk to develop diseases
• DSM codes physical disorders on Axis III: Psychological factors affecting medical condition
DSM
• A. A general medical condition is present (Axis III)
• B. Psychological factors adversely affect the general medical condition in one of the following ways:• 1. influence course of the condition such
as close relationship between psychological factors and development, exacerbation or delayed recovery from medical condition
• 2. factors interfere with tx of med condition
DSM…
• Stress-related responses precipitate or exacerbate medical condition
DSM examples
• Depression delaying recovery from heart attack
• Anxiety exacerbating asthma• Denial of need for surgery• Hostility and pressured behavior
contributing to heart attack• Maladaptive behaviors
(overeating ,unsafe sex, lack of exercise)
• Stress related responses
Psychosocial factors
• AIDS• Influenced by stress and behavioral
patterns
• 50% of all deaths from 10 leading causes of death in the USA traced to life-style
Defining stress
• 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
stressors
• The events themselves• Stressful experiences
Person-environment fit
• Consequence or appraisal:• Resources sufficient to meet the
demands of the environment?
Early theories
• Fight or flight response• Selye: General Adaptation Syndrome
• Alarm• Resistance• exhaustion
Tend and Befriend
• Affiliative responses to stress• Especially in females, fight or flight
may lead to social and nurturant behaviors
• Oxytocin: stress hormone especially modulated by estrogen
Psychological Appraisal and the experience of stress
• Primary appraisal• Is the event positive, neutral or negative
in its implications?• If negative, to what extent is it
presently harmful, threatening for the future, and potentially challenging
Secondary Appraisal
• Are coping abilities and resources sufficient to overcome the harm, threat or challenge posed by the event?
• Physiological, cognitive, emotional behavioral responses
The physiology of stress
• Sympathetic-adrenomedullary system (SAM)
• Hypothalamic-pituitary-adrenocortical axis (HPA)
• Repeated activation leads to cumulative damage
Physiology of stress
• Activates sympathetic nervous system• Neurotransmitters and neuromodulators
(neuropeptides)
• CRF : corticotrophin releasing factor• Pituitary>adrenal gland>corticosteroids• Cortisol: the stress hormone
• Hippocampus; emotional memory, helps turn off stress response
Hippocampus
• Cortisol impacts Hippocampus and may diminish its ability to turn off stress response
• Cortisol may influence memory functioning
• Chronic state or arousal
premature aging
• Allostasis: physiological systems fluctuate to meet demands of stress
• Over time problems include:• Immune system• Inability to shut off cortisol• Lowered heart rate variability• Elevated epinephrine levels• Decrease hippocampus volume?
What makes events stressful?
• Events are stressful to the extent that they are perceived as stressful
• Negative events more stressful than positive events
• Uncontrollable events more stressful than controllable or predictable events
• Ambiguous events often perceived as more stressful than clear-cut events
What makes events stressful?
• Overloaded people more stressed than people with fewer tasks to perform
Which stressors?
• Central life domains• Investment of self• Example : parenting role• Example : single mothers
Adaptation
• To mild stressors• Severe stress causes chronic
problems:• Persistent arousal• Psychological distress• Reduced task performance• Gradual reduction in cognitive
capabilities
Psychoneuroimmunology
• Behavioral factors• CNS• Immune system• health
model
• Stressful life events impact• Immune functioning which modifies• Host resistance to immune-related
diseases
Immune functioning
• Implications of stress induced immune changes for susceptibility to disease not yet established
• Small but significant changes in immune functioning
• People under stress report more URI
Upper respiratory illness
• Major stressful events• Chronic family conflict• Disruptive daily events• Increase risk of URI
Latest studies
• Experimental inoculation of virus (virus challenge studies)
• Negative mood prior to exposure= greater severity of colds and flu
• But…….• Multiple pathways….
Psychosocial factors
• Changes in health-related behaviors• Poor nutrition, smoking, drug and
alcohol, lack of exercise, poor sleep
• Must be other mechanisms working as these factors do not account for all variability
Physiological markers
• Few basic markers that provide poor overall estimate of ability to resist disease
Immunocompetence
• Limited to blood and saliva studies• Percentage/absolute numbers of
immune cells• Immune cells incubated with
antigens: resultant proliferation as measure
• Antibody production in response to inoculation
immunocompetence
• Antibody response generally thought good indicator , however..
• Herpes virus: elevated response means weakened immune system
Chronic stressors & immune changes
• Job stress• Long-term unemployment• Loss of relationship through death• Separation/divorce• Caring for relative with Alzheimer's• Natural disasters• May persist with prolong stressor
exposure
Chronic stressors & immune changes
• Bereavement• May be related more to level of
depression
• Caregivers• Higher levels of depression, higher
reports of illness and decreased life satisfaction