Transcript Physical Disorders and Health Psychology

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