Transcript Basic Statistics for the Behavioral Sciences

Chapter 7
Physical Disorders and Health
Psychology
Psychological and Social Factors that
Influence Health
• Psychological, behavioral, and social factors
– Are major contributors to medical illness and
disease
– Examples
• Genital herpes, AIDS, cancer, cardiovascular diseases
Psychological and Social Factors that
Influence Health
• DSM-IV-TR and physical disorders
– Coded on Axis III
– Recognize that psychological factors affect medical
conditions
• Psychological approaches to health and
disease
– Behavioral medicine – study of factors affecting
medical illness
– Health psychology – promotion of health
How Do Psychological and Social
Factors Influence Medical Illness?
• Two primary paths
– Psychological factors can influence basic biological
processes
– Long-standing behavior patterns may put people
at risk for disease
• AIDS is an example of both forms of influence
• Leading causes of death in the U.S.
– 50% are linked to lifestyle and behavior patterns
Overview of Stress and the Stress
Response
• Nature of stress
– Stress – physiological response of an individual
– Stressor – event that evokes stress response
– Stress responses vary from person to person
Overview of Stress and the Stress
Response
• The stress response and the general
adaptation syndrome (GAS)
– Phase 1 – alarm response (sympathetic arousal)
– Phase 2 – resistance (mobilized coping and action)
– Phase 3 – exhaustion (chronic stress, permanent
damage)
Physiology of Stress
• The biology of stress
– Activates the sympathetic branch of the ANS
– Neuromodulators and neuropeptides act like
neurotransmitters
– Activates the HPA axis, producing cortisol
– The relation between the hippocampus and HPA
activation
Physiology of Stress
• The function of the hippocampus in
HPA-stress response cycle
– Part of the limbic system
– Highly responsive to cortisol
– Hippocampus helps to turn off the HPA cycle
– Chronic stress may damage cells in the
hippocampus
– Damage to hippocampal cells interferes with
stopping the HPA loop
Stress, Anxiety, and Excitement
• Primate research: High and low social status
– High cortisol is associated with low social status
– Low social status – fewer lymphocytes and
immune suppression
– Dominant males benefit from predictability and
controllability
Stress, Anxiety, and Excitement
• Vulnerabilities in mental illness contribute to
physical illness
– Stress
– Perceived uncontrollability, low social support,
negative affect
• Interpretation of physiological response and
situation
– Seems critical in the stress response
– The role of self-efficacy
Stress and the Immune Response
• Divisions of the immune system
– Humoral branch
• Blood and other bodily fluids
– Cellular branch
• Protects against viral and parasitic infections
• Function of the immune system
– Identify and eliminate antigens from the body
– Leukocytes are the primary agents
Stress and the Immune System: The
Role of Leukocytes
• 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 and T cells and associated
memory cells
Stress and the Immune System: The
Role of Leukocytes
• Stress dramatically and quickly alters immune
function
• Autoimmune disease
• Rheumatoid arthritis
• Psychoneuroimmunology (PNI)
Acquired Immunodeficiency Virus
(AIDS)
• Nature of AIDS
– 33.4 million cases in 2008
– Course from HIV to full blown AIDS is variable
– Median time from initial infection to full-blown
AIDS?
• 7.3 to 10 years or more
– Stress of getting an AIDS diagnosis can be
devastating
– AIDS-related complex (ARC)
– HAART
Acquired Immunodeficiency Virus
(AIDS)
• Role of stress reduction programs
– Higher stress and low social support speed disease
progression
– Reduce stress, improve immune system
functioning
• The development and course of AIDS
– Influenced by psychological, behavioral, and social
factors
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 or inappropriate coping responses
(e.g., denial)
Cancer: Psychological and Social
Influences
– Overwhelming, stressful life events
– Lifestyle risk behaviors
– Psychological factors also are involved in
chemotherapy
• Cancer is influenced by psychological,
behavioral, and social factors
Breast Cancer Support and Education
• Women with…
–
–
–
–
–
low self-esteem
low body image,
feelings of low control
low optimism
a lack of support at home
• …were even more likely to benefit from an
education intervention
Cardiovascular Problems: Hypertension
• Cardiovascular system: An overview
– Heart and blood vessels
– Mechanisms for regulating their function
• Hypertension – high blood pressure
– Major risk factor for stroke, heart disease, and
kidney disease
– Causes wear and tear of the blood vessels
– Essential hypertension is the most common form
Cardiovascular Problems: Hypertension
• Contributing factors and associated features
– Affects 27.6% of all adults (between ages of 35
and 64)
– 29% for everyone over 18 years
– African Americans are most at risk
– Affected by salt, fluid volume, sympathetic
arousal, and stress
– Psychological contributors include anger and
hostility
• Influenced by psychological, behavioral, and
social factors
Cardiovascular Diseases: Coronary
Heart Disease (CHD)
• Coronary heart disease (CHD)
– Blockage of the arteries supplying blood to the
heart muscle
– Angina pectoris
• Chest pain from partial obstruction of the arteries
– Atherosclerosis
• Accumulation of artery plaque (i.e., fatty substances)
– Ischemia
• Deficiency of blood supply because of too much plaque
– Myocardial infarction
• Heart attack involving death of heart tissue
Cardiovascular Diseases: CHD
• Psychological and behavioral risk factors for
CHD
– Stress, anxiety, anger,
– Poor coping skills
– Low social support
– Lifestyle factors (e.g., smoking, diet, exercise)
– Classic type A behavior pattern
• Anger and negative affect
• Impatience, accelerated speech and motor activity
Cardiovascular Diseases: CHD
• The role of chronic negative emotions
• CHD is influenced by psychological, behavioral,
and social factors
Chronic Pain
• Acute vs. chronic pain
– Acute pain vs. chronic pain
– Severity of pain does not predict one’s reaction to
it
• Pain: Some clinical distinctions
– Subjective vs. overt behavioral manifestations of
pain
Chronic Pain
• Psychological and social aspects of 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: An integrative account
• The role of endogenous opioids
Chronic Pain
• Biological aspects of pain
– Gate control theory: An integrative account
– The role of endogenous opioids
– Gender differences in pain
Chronic Fatigue Syndrome: Psychological,
Behavioral, and Social Influences
• Nature of chronic fatigue (CF)
– Lack of energy, marked fatigue, pain, low-grade
fever
– Most common in females
– Incidence increasing in Western countries
– Unrelated to viral infection, immune problems,
depression
Chronic Fatigue Syndrome: Psychological,
Behavioral, and Social Influences
• Speculation about causes
– High-achievement oriented lifestyle
– Fast paced lifestyle combines with stress and
illness
– Psychological misinterpretation of consequences
of illness
Chronic Fatigue Syndrome: Psychological,
Behavioral, and Social Influence
• Treatment
– Medications are ineffective
– Cognitive-behavioral interventions appear
promising
Psychosocial Treatment of Physical
Disorders
• Biofeedback: An overview
– Patient learns to control bodily responses
– Used with chronic headache and hypertension
• Relaxation and meditation
– Progressive muscle relaxation
– Transcendental meditation (TM)
Psychosocial Treatment of Physical
Disorders
• Comprehensive stress reduction and pain
management programs
– More effective and durable than individual
interventions alone
– Drugs and Stress-reduction programs
– Denial as a means of coping
Modifying Behaviors to Promote
Health
• Lifestyle practices – core of many health
problems
– Behavioral risk factors are also influenced by
psychosocial factors
– Prevention and intervention programs target
behavioral risks
Modifying Behaviors to Promote Health
• Types of lifestyle behaviors
– Injury and injury prevention
• Repeated warnings are not enough
– AIDS prevention
• Highly preventable by changing behaviors
– Diet, exercise, promotion of health and wellness
– Stanford Three Community Study
Summary of Physical Disorders and
Health Psychology
• Psychological factors play a major role in
physical disorders
– Behavioral medicine and health psychology
• Psychological and social factors: Their role in
illness and disease
– Stress, immune function, and disease
– Such influences interact with other psychosocial
factors
Summary of Physical Disorders and
Health Psychology
• Risk for physical illness
– Related to long-standing patterns of behavior &
lifestyle factors
• Psychosocial treatments
– Aim to prevent and/or treat physical disorders
– Comprehensive individual or community programs
are best
DSM-5 Proposed Changes
• http://www.dsm5.org/ProposedRevisions/Pag
es/OtherClinicalConditionsThatMayBeaFocuso
fClinicalAttention.aspx