Chapter 7 Physical Disorders and Health Psychology

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Chapter 7Physical Disorders and Health Psychology
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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

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Psychological and Social Factors that Influence
Health (continued)

• 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

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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

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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

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Overview of Stress and the Stress Response
(continued)

• The Stress Response and the General Adaptation
  Syndrome
• Phase 1 Alarm response (sympathetic arousal)
• Phase 2 Resistance (mobilized coping and
  action)
• Phase 3 Exhaustion (chronic stress, permanent
  damage)

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Physiology of Stress

• The Biology of Stress
• Activates the sympathetic branch of the ANS
• Activates the HPA axis, producing cortisol

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Physiology of Stress (continued)

• 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

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Psychological and Social Factors Their
Relation to Stress Physiology

• 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

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Psychological and Social Factors Their Relation
to Stress Physiology (continued)

• 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

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Stress and the Immune System

• 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

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Fig. 7.3, p. 269
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Stress and the Immune System The Role of
Leukocytes

• Leukocytes Subtypes and Functions
• Macrophages
• First line of defense, destroy antigens, signal
  lymphocytes

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Stress and the Immune System The Role of
Leukocytes (continued)

• 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 Dramatically and Quickly Alters Immune
  Function

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Acquired Immunodeficiency Virus (AIDS)

• Nature of AIDS
• 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

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Acquired Immunodeficiency Virus (AIDS) (continued)

• 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

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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)

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Cancer Psychological and Social Influences

• Overwhelming stressful life events
• Life-style risk behaviors
• Psychological factors also are involved in
  chemotherapy
• Cancer is Influenced by Psychological,
  Behavioral, and Social Factors

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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

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Cardiovascular Problems Hypertension (continued)

• Contributing Factors and Associated Features
• Affects 20 of all adults (between ages of 25 and
  74)
• 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

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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)

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Cardiovascular Diseases Coronary Heart Disease
(CHD) -continued

• Ischemia
• Deficiency of blood supply because of too much
  plaque
• Myocardial infarction
• Heart attack involving death of heart tissue

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Cardiovascular Diseases Coronary Heart Disease
(CHD) -continued

• Psychological and Behavioral Risk Factors for CHD
• Stress, anxiety, anger,
• Poor coping skills
• Low social support
• Lifestyle factors (e.g., smoking, diet, exercise)

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Cardiovascular Diseases Coronary Heart Disease
(CHD) -continued

• Classic Type A Behavior Pattern
• Anger and negative affect
• Impatience, accelerated speech and motor activity
• CHD Is Influenced by Psychological, Behavioral,
  and Social Factors

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Chronic Pain

• Acute vs. Chronic Pain
• Acute pain vs. chronic pain
• Severity of pain does not predict ones reaction
  to it
• Pain Some Clinical Distinctions
• Subjective vs. overt behavioral manifestations of
  pain

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Chronic Pain (continued)

• Psychological and Social Factors in Chronic 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 Opiods

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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

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Chronic Fatigue Syndrome Psychological,
Behavioral, and Social Influences (continued)

• Speculation About Causes
• High-achievement oriented lifestyle
• Fast paced lifestyle combines with stress and
  illness
• Psychological misinterpretation of consequences
  of illness

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Chronic Fatigue Syndrome Psychological,
Behavioral, and Social Influences (continued)

• Treatment
• Medications are ineffective
• Cognitive-behavioral interventions appear
  promising

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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)

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Psychosocial Treatment of Physical Disorders
(continued)

• Comprehensive Stress Reduction and Pain
  Management Programs
• More effective and durable than individual
  interventions alone

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Modifying Behaviors to Promote Health

• Life-Style Practices Core of Many Health
  Problems
• Behavioral risk factors are also influenced by
  psychosocial factors
• Prevention and intervention programs target
  behavioral risks

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Modifying Behaviors to Promote Health (continued)

• Types of Life-Style Behaviors
• Injury and injury prevention
• Repeated warnings are not enough
• AIDS
• Highly preventable by changing behaviors
• China and smoking cessation programs
• Diet, exercise, promotion of health and wellness
• Stanford three community study

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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

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Summary (continued)

• Risk for Physical Illness
• Related to long-standing patterns of behavior
  life-style factors
• Psychosocial Treatments
• Aim to prevent and/or treat physical disorders
• Comprehensive individual or community programs
  are best