abnormal PSYCHOLOGY Fourth Canadian Edition Chapter 9 Psychophysiological Disorders and Health Psychology Prepared by: Tracy Vaillancourt, Ph.D. Modified by: Réjeanne Dupuis, M.A.

Chapter Outline Stress and Health Theories of the Stress-Illness Link Cardiovascular Disorders Socio-Economic Status, Ethnicity, and Health Therapies for Psychophysiological Disorders

Psychophysiological Disorders Psychophysiological Disorders — characterized by genuine physical symptoms caused by or worsened by emotional factors –Examples: asthma, hypertension, headache, and gastritis –Used to be termed psychosomatic disorders DSM-IV requires diagnostic judgment to indicate presence of psychological factors affecting medical condition –Coded in DSM-IV as “other conditions that may be a focus of clinical attention” Diagnosis is applicable to any disease The field is called Health Psychology and Behavioural Medicine

Psychophysiological vs. Conversion Disorders

Stress Stress— environmental condition that triggers psychopathology Term “stress” was created by Hans Selye –General Adaptation Syndrome (GAS)

Nervous System 1. Autonomic Nervous System Stimulates endocrine glands, heart, and smooth muscles found in the walls of the blood vessels, stomach, intestines, kidneys, and other organs ANS is divided into 2 parts: –Sympathetic nervous system –Parasympathetic nervous system 2. Somatic Nervous System Voluntary nervous system

Nervous System and Health Growing evidence that chronic activation of the sympathetic NS is directly linked to health problems –Focus is on stress as a stimulus (referred to as stressor) –Examples: Electric shock, boredom, uncontrollable stimuli, catastrophic life events, daily hassles, and sleep deprivation Stressors distinguished in terms of whether they are psychogenic (from psychological factors) or neurogenic (from physical stimulus) –Allostatic load

Coping Problem-focused coping –Taking direct action to solve the problem or seeking information that will be relevant to the solution; most adaptive when the individual can do something about the situation Emotion-focused coping –Efforts to reduce the negative emotional reactions to stress; most adaptive when the situation is uncontrollable Goodness of fit hypothesis –The adaptivity of a particular coping response depends on the match between the coping response and what is called for ideally by the problem situation

Measuring Stress The Social Readjustment Rating Scale Assessment of Daily Experiences –Daily hassles Stress in Specific Contexts –Job stress –Job spillover –Job burnout Vital exhaustion

Assessing Coping

Health Status of Students Little evidence showing that college/ university students have comparative health status as other populations Predictors of less positive health status in students: –In Canada: Poorer child-parent relationship; Low interest and achievement in school; Lower self-esteem and being a female –In Europe: Best predictors of negative self-rating in European students were psychosomatic symptoms Top health problems in students: –Allergy (47.9%), back pain (41.6%), sinus infection (30.7%), depression (17.0%), strep throat (13.8%) Top 5 factors interfering with academic performance: –Stress (33.9%), cold/flu/sore throat (28.2%), sleep difficulties (25.6%), concern for troubled friend/family member (18.8%), Internet use/computer games (16.9%)

Interactional Model of Anxiety, Stress, and Coping Essence: Personality traits (trait anxiety) interact with situational factors to produce behaviours (state anxiety) The Coping Inventory for Stressful Situations (CISS) 1. Emotion-oriented 2. Task-oriented 3. Avoidance-oriented Coping with Health Injury Problems (CHIP) 1. Emotional preoccupation 2. Distraction 3. Instrumental coping (task-oriented) 4. Palliative coping (attempts to feel better via self-soothing and self-help by doing things such as staying in bed or resting when tired)

Moderators of Stress-Illness Link Social Support Structural social support –Person’s basic network of social relationships Functional social support –Quality of a person’s relationships Emotional support –Provides the recipient with a sense of being cared for by warm and sensitive others Instrumental support –Provides the recipient with more tangible forms of assistance Social support linked to health –People with few friends or relatives tend to have a  mortality rate –  levels of functional support linked to  atherosclerosis and ability of women to adjust to chronic rheumatoid arthritis

Theories of Stress-Illness Link In considering the etiology of psychophysiological disorders 3 important questions are raised: 1. Why does stress produce illness in only some people who are exposed to it? 2. Why does stress sometimes cause an illness and not a psychological disorder? 3. When stress produces a psychophysiological disorder, what determines which one of the many disorders will be produced?

Biological Theories Somatic-Weakness Theory –Weakness in a specific body organ –Example: congenitally weak respiratory system might predispose the individual to asthma Specific-Reaction Theory –Individuals response to stress is idiosyncratic Prolonged Exposure to Stress Hormones –Activation of SNS and HPA axis ( see Figure 9.5) Stress and the Immune System –Stress impact the ANS, hormone levels, brain activity ( see Figure 9.6)

HPA Axis

Stress and the Immune System

Psychological Theories Psychoanalytic Theory –Anger-in theory

Gender and Health Women live longer but report being less healthy than men Women have lower rates of obesity and being overweight (39% in women and 59% in men) Women experience more disabilities as compared to men due to poor health Greater morbidity among women than men Hormone replacement therapies appear to protect women from mortality Critical determinants of health status in men: smoking an alcohol consumption; in women: caring for a family, social support, being in the highest income Mortality rates gap is decreasing in women and men

Cardiovascular Disorders Diseases involving heart and blood-circulation system –Hypertension –Coronary heart disease Essential Hypertension –Hypertension without evident biological cause Primary hypertension –Known as the silent killer Measurement of blood pressure (BP) –Systolic pressure Amount of arterial pressure when ventricles contract and heart is pumping –Diastolic pressure Degree of arterial pressure when ventricles relax and heart is resting –Normal blood pressure in a young adult is 120/ 80

Risk Factors for High BP

Predisposing Factors of CVDs Blood pressure and hypertension considered as highly heritable (potentially 13 gene regions) Cardiovascular reactivity and coronary heart disease as predispositions 1. Reactivity must have predictive power 2. Laboratory measures must correspond to daily activities (thus eliminating lab-coat hypertension) Results: Hypertension is related to race and social class, obesity, excessive alcohol, family history of hypertension

Coronary Heart Disease (CHD) CHD takes 2 principal forms: Angina pectoris –Periodic chest pains –Cause of pain—insufficient supply of oxygen to heart (ischemia) due to coronary atherosclerosis Myocardial infarction (heart attack) –Much more serious disorder –Like angina pectoris BUT usually results in permanent damage to the heart

Risk Factors of CHD Age Sex (males are at greater risk) Cigarette smoking Elevated blood pressure Elevated serum cholesterol  size of the left ventricle in heart Obesity Long-standing pattern of physical inactivity Excessive use of alcohol Diabetes

Stress and Myocardial Infarction One current theory –Chronic stress activates immune system and contributes to inflammation, which, in turn, produces CHD Diatheses for CHD –Traditional risk factors (see previous slide) –Psychological Diatheses Type A behaviour pattern –Intense and competitive drive for achievement and advancement; Exaggerated sense of the urgency; Aggressiveness and hostility toward others Type D (distressed) personality –Negative affectivity + social inhibition, including the inhibition of anger, anxiety and depression –Biological Diatheses Heart-rate reactivity

SES, Ethnicity, and Health SES and Health Low socio-economic status (SES) is associated with  rates of mortality from all causes –  SES more likely to engage in behaviours that  risk for disease –Smoking, eating a high-fat diet, and drinking excessive amounts of alcohol Social gradient of health –Inequalities in SES reflect inequalities in health status –  SES also confers health disadvantages because linked with  sense of perceived controllability

Therapies Treating hypertension and CHD risk –  anxiety, depression, or anger best way to  psychophysiological disorders –Also  smoking, obesity, alcohol consumption, salt intake,  exercise, etc. –Drugs can be used to  cholesterol levels Lovastatin (trade name Mevacor) lowers low-density lipid cholesterol Biofeedback –Effectiveness of biofeedback is not supported Cardiac Rehabilitation Efforts –Effectiveness studies show mitigated results

Stress Management Arousal Reduction –Person trained in muscle relaxation, sometimes assisted by biofeedback Cognitive Restructuring –See approaches by Ellis (1962) and Beck (1976) –Focus is on altering belief systems and improving the clarity of logical interpretations of experience Mindfulness –A manualized 10-week group approach to develop mindful awareness of perceptible experiences in a way that is non- evaluative and emotionally non-reactive Behavioural Skills Training –Learning and practicing required skills, including assertion skills

Pain Management How common are problems with pain? –3.6 million Canadians perceived activities restricted by physical problems Most common disabilities are linked with pain Gate-control theory of pain –Nerve impulses connoting pain reach spinal column and spinal column controls pain sensations sent to brain –Gate—area of the spinal column known as the dorsal horns Acute Pain –Sense of personal control important in dealing with acute pain Chronic Pain –Traditional medical treatments seldom help with chronic pain –Maladaptive strategy for coping with pain Catastrophization

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