Psychophysiological Disorders and Health Psychology Chapter 9 Psychophysiological Disorders and Health Psychology

Chapter Outline Stress and Health Theories of the Stress-Illness Link Cardiovascular Disorders Socio-Economic Status, Ethnicity, and Health Therapies for Psychophysiological Disorders Source: page 2

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 required diagnostic judgment to indicate presence of psychological factors affecting medical condition DSM-5 considers that psychiatric disorders and medical disorders are NOT distinct. eliminated DSM-IV-TR Axis III – General medical conditions The field is called Health Psychology and Behavioural Medicine Prevention is a major focus

Psychophysiological vs. Conversion Disorders

Stress coined by Canadian scientist Hans Selye (“father” of stress) refers to environmental conditions that trigger psychopathology General Adaptation Syndrome (GAS) outlines the effects of sustained and unrelenting stress on our bodies, resulting in illness

Key Terms Stressor – stress as a stimulus Examples found in research: electric shock, boredom, uncontrollable stimuli, catastrophic life events, daily hassles, and sleep deprivation Two main kinds of stressors Psychogenic Psychological factors Example: anticipation of bad things happening Neurogenic Physical stimulus Example: Bodily injury

Stress and the Nervous System 1. Autonomic Nervous System (ANS) Involuntary (automatic) response to stimuli ANS is divided into two parts: Sympathetic nervous system Parasympathetic nervous system Sympathetic nervous system responsible for dilating pupils,  heart rate,  digestion etc. 2. Somatic Nervous System Voluntary nervous system

Nervous System and Health Sympathetic nervous system is important for responding to acute danger – ‘fight or flight’ response however, chronic activation of the sympathetic nervous system is directly linked to health problems, according to research Allostatic load refers to ‘wear and tear’ on the body when there is exposure to intense and prolonged demands

Measuring Stress The Social Readjustment Rating Scale Stress is defined by major life events Scores are referred to as Life Change Units arbitrarily assigned marriage as middle ranked event highest stress event – death of a spouse Research:  life events (life changes),  illness

Measuring Stress (cont.)

Measuring Stress (cont.) Life events scale criticized because it does not account well for day to day stressors termed: daily hassles Cognitive appraisals (Lazarus, 1966) are also important in understanding stress determines whether situations are viewed as ‘stress’ or ‘challenge’ (like a glass half-empty or half-full)

Burnout usually related to job stress linked to physical problems as well as psychological problems such as depression characterized by: emotional exhaustion tendency to be insensitive lack sense of personal accomplishment Vital exhaustion – extreme form of burnout

Coping and Stress 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

Ways of Coping

Stress and Illness Health Status of Students Research shows college/ university students do not rate themselves as having better health even compared with older populations Predictors of less positive health status in students: Poorer child-parent relationship; Low interest and achievement in school; Lower self-esteem and Women reported more health problems than male students Top health problems in students: Allergy (47.9%), back pain (41.6%), sinus infection (30.7%), depression (17.0%), strep throat (13.8%) Top five 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%)

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

Psychophysiological Disorders Theories of Stress-Illness Link Three important questions related to causes of psychophysiological disorders: 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?

Psychophysiological Disorders (cont.) 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 Individual response to stress is idiosyncratic Prolonged Exposure to Stress Hormones Activation of SNS and HPA axis (see next - Figure 9.6) Stress and the Immune System Stress impact the ANS, hormone levels, brain activity (see next - Figure 9.7)

HPA Axis

Stress and the Immune System

Psychophysiological Disorders (cont.) Psychological Theories Psychoanalytic Theory Specific unconscious emotional states are associated with specific psychophysiological disorders Anger-in theory has been researched as possible contributor to essential hypertension

Cardiovascular Disorders Two diseases involving heart and blood-circulation system appear to be adversely affected by stress Essential Hypertension Coronary Heart Disease (CHD) Hypertension without identified biological cause Sometimes called: Primary hypertension Known as the silent killer (may go undetected for years) 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

Cardiovascular Disorders (Cont.) Risk Factors for High BP

Cardiovascular Disorders (Cont.) Predisposing Factors Genetics – still little success in identifying specific genes Biology – heightened cardiovascular reactivity in response to exposure to stressors Psychology - acute stress such as anger episodes and physical exertion can trigger myocardial infarction Chronic stress (marital conflict, financial worries) activates immune system and contributes to inflammation, which, in turn, produces coronary heart disease

Cardiovascular Disorders (Cont.) 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 Similar to angina pectoris BUT usually results in permanent damage to the heart

Cardiovascular Disorders (Cont.) 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

Cardiovascular Disorders (Cont.) Psychological Diatheses Psychological Diatheses (predispositions) 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

Cardiovascular Disorders (Cont.) SES, Ethnicity, 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 are considered to reflect inequalities in health status  SES also confers health disadvantages because linked with  sense of perceived controllability

Therapies for Psychophysiological Disorders Treating hypertension through  CHD risk factors  anxiety, depression, or anger is best way to  psychophysiological disorders Also  smoking, obesity, alcohol consumption, salt intake,  exercise, etc. Drugs can be used to  cholesterol levels Lovastatin (Mevacor) lowers low-density lipid cholesterol Biofeedback Effectiveness of biofeedback has only modest empirical support Cardiac Rehabilitation Efforts Support and counseling aimed at  stress

Stress Management Arousal Reduction training 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  trait mindfulness associated with  pain catastrophization manualized 10-week group approach for developing 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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