Transcript Psychology 415: Social Basis of Health Behavior

Psychology 415; Social Basis of Health Behavior
The stimulus
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Self-efficacy:
Sources of efficacy judgments
Psychology 415; Social Basis of Health Behavior
 Feedback re: behavioral subgoals (Cf: Karoly, Carver models)
 Sub-goals: concrete, specific  discernable feedback
 Attitude change: Behavior  attitude
 “Guided mastery” interventions
 Modeling
 Bandura & Walters:
 Coping model >> Mastery model
 Controls resources > rewarded > simple performance
 Similarity of model to participant: Peer-based interventions
 Social persuasion
 Normative / personal information
 Social network mechanism?
 Feedback post performance > simple attitude change
 Interpretation of somatic information
 E.g., “fear of fear”
 Cognitive representation of disease
 Miller C-SHIP model: Rx to “hot” disease or physical information
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Perceived control and stress
 Averill, types of control:
Psychology 415; Social Basis of Health Behavior
 Behavioral
 Brown: Bereavement  stress  mortality
 Learned helplessness
 Decisional
 Singer: stress Rx & perceived controllability
 Interpretative
 Taylor: “search for meaning” & coping w/cancer
 “Hopelessness” & depression
 Predictive
 DV literature / Averill data: predictability >> aversiveness
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Psychology 415; Social Basis of Health Behavior
Efficacy training  immune system
Immune parameters
x
Efficacy training stage
x
“Enhancer” v.
“Suppressor” group
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Perceived control & stress, 2
 Bandura;
Psychology 415; Social Basis of Health Behavior
 Consequences of low perceived control
 Subjective stress & negative affect
 Health risk behavior
 Autonomic activation
 HPA activation
 Plasma catecholamine secretion
 HPA activation decreased lymphocyte proliferation
 Induced self-efficacy
 Rapid efficacy gain  immuno-enhancing
 High cortisol release  immuno-suppressant
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Self-discrepancies & affect
Psychology 415; Social Basis of Health Behavior
Actual
Own
Other
Ideal
Own
Other
Ought
Own
Other
Depression, disappointment
Dejection, loss of esteem
Fear, perceived threat
Guilt, self-recrimination
Anxiety, fear, social anxiety
Depression, sadness, self-disappointment
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Psychology 415; Social Basis of Health Behavior
Self-discrepancy model of stress.
Actual (selfrated) stressful
events
Chronic
availability of
self-discrepancy
 Ideal :: Actual
 Ought :: Actual
?
?
Acute negative
self- appraisal
Contextual
activation of selfdiscrepancy
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Cortisol
secretion
?
Negative affect
 Depression
 Anxiety
NK suppression
Psychology 415; Social Basis of Health Behavior
Primed self-discrepancies  NK activation
 “Normal” Ss show immune
enhancement after
priming with yoked stimuli
 Dysphoric Ss show
immune suppression
after self-priming with
“ideal” stimuli
 Anxious Ss show immune
suppression after selfpriming with “ought”
stimuli
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Robles et al.: Balanced immune responses
 Inflammation:
Psychology 415; Social Basis of Health Behavior
 attracts immune cells to
injury site
 Induce adaptive
“sickness behavior”
 Activates HPA axis
 HPA activation:
 Stimulates cortisol
production
 Down-regulates proinflammatory cytokines
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Macrophages etc.
Robles: Stress – modulated immune responses.
A. Brain effects of stress:
Psychology 415; Social Basis of Health Behavior
 Reduce glucocorticoid
receptors
 Disrupt receptor functioning
 Dysregulate HPA axis
 Decrease threshold for HPA
arousal in response to stress
 Possible chronic HPA arousal
 Cortisol production
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Immune
suppression
Robles: Stress – modulated immune responses, 2.
B. Cellular effects of stress:
Psychology 415; Social Basis of Health Behavior
 Disrupt functioning of
corticoid receptors on
cytokine-producing cells
 Less sensitive to the antiinflammatory effects of
cortisol
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Robles: Stress – modulated immune responses, 2.
C. Immune suppression from
Psychology 415; Social Basis of Health Behavior
stress / negative affect:
 HPA activation  cortisol 
immune suppression
 Inhibits ability to fight off
infection
 Chronic infections
 Inflammation
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Robles: Stress – modulated immune responses, 2.
D. Proinflammatory cytokines
Psychology 415; Social Basis of Health Behavior
 Reduce or disrupt glucocorticoid
receptors in the brain
 All four mechanisms
 Chronic elevated production of
proinflammatory cytokines
 Direct effects on chronic disease
and pathophysiology
 Indirect via, e.g., production of Creactive protein.
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CRP
Behavioral intervention designs
Psychology 415; Social Basis of Health Behavior
 Stress management
Not typical: direct
affect regulation
(DBT) skills.
 Education
 Cognitive restructuring (simplified CBT)
 Coping skills training
 Support provision
 Relaxation
 Deep muscle
 “Autogenic”
 Mindfulness
 Disclosure
 Kemeny group: disclosure of sexual orientation
 Pennebaker: systematic writing / “uplifting” language
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Appraisal
Psychology 415; Social Basis of Health Behavior
Unmeasured
moderators
Perceived
threat /
vulnerability
Chronic (?)
stress
Perceived
control / selfefficacy
Perceived
Stress
Mediating
responses
Subjective
(dis)stress
Life events
Coping
Ψ
closeness
Approach /
active coping
Arousal &
activity
Avoidant /
affective
coping
Risk behavior:
tobacco, etoh,
drugs & sex…
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Catecholamine / corticosteroid / HPA

cellular & humoral immune cascade
Stress & coping model of immune supression
Psychology 415; Social Basis of Health Behavior
Appraisal
Perceived
threat /
vulnerability
Chronic (?)
stress
Perceived
control / selfefficacy
Perceived
Stress
Negative
affect
 Depression
 Neuroticism
 Poor affect
regulation
 Affect or
thought
suppression
Coping
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Approach /
active coping
Arousal &
activity
Avoidant /
affective
coping
Risk behavior:
tobacco, etoh,
drugs & sex…
Catecholamine / corticosteroid / HPA

cellular & humoral immune cascade
Alternate conceptualization
Stress & coping intervention model
Psychology 415; Social Basis of Health Behavior
Appraisal


Perceived
threat /
vulnerability
Perceived
control / selfefficacy
Mediating
responses

Subjective
(dis)stress
 Cognitive reframing,
 Basic CBT techniques
 Bandura-esque selfefficacy training
 Coping skills training
Coping

Approach /
active coping
Arousal &
activity
Avoidant /
affective
coping
Risk behavior:
tobacco, etoh,
drugs & sex…
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
 Relaxation training
 Depression treatment
 Behavioral
interventions
Thorton et al., Relaxation training  NA  inflammation
 Study population
 n = 45 breast cancer patients w / “clinically
Psychology 415; Social Basis of Health Behavior
significant” depression scores on CES-D
 (20% of patient population)
 M = 45 days post-surgery
 Intervention
 Group-based (8-12 pt.)
 4 months of weekly 90 min. sessions, 8 months of
monthly sessions
 Targets:
 reduce stress & emotional distress
 enhance social adjustment,
 improve compliance with cancer treatment
 enhance health behaviors.
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Thorton et al., results
 Clear effects on 3
Psychology 415; Social Basis of Health Behavior
core Ψ outcomes:
 Depression
 Fatigue
 Pain tolerance
 Asymptote about 8
months
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Thorton et al., results, 2
Psychology 415; Social Basis of Health Behavior
 More modest, but
significant effects on
immune / inflammation
markers
 WBC counts
 T helper :: suppressor ratio
 Δ in Ψ variables  less
inflammation
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