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Stress and Health § Behavioral Medicine § interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease § Health Psychology § subfield of psychology that provides psychology’s contribution to behavioral medicine § Behavioral Medicine § interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease § Health Psychology § subfield of psychology that provides psychology’s contribution to behavioral medicine

Stress and Illness § Leading causes of death in the US in 1900 and 2000

Stress and Illness § Stress § the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging § Stress § the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging

When stress is good and leads to something desirable such as studying for a big exam and then receiving a good grade on the exam, it is called eustress. When the stress has negative effects such as confusion, an inability to make decisions, and illness, it is called distress. Stress Stress is defined as the physical pressure and strain that result from change.

Stress Appraisal Stressful event (tough math test) Threat (“Yikes! This is beyond me!”) Challenge (“I’ve got to apply all I know”) Panic, freeze up Aroused, focused Appraisal Response

Sequence of Steps in the Fight or Flight Behaviors 1. The brain appraises a situation as threatening and dangerous. 2. The lower brain structure secretes a stress hormone. 3. The stress hormone signals the adrenal glands to secrete adrenaline. 4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles. Fight or Flight (Walter Cannon)

The General Adaptation Syndrome (Hans Selye) Defined as a series of stages the body goes through when exposed to stressful situations. 1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical. 2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor. 3. The third stage is exhaustion. It is marked by body exhaustion and health problems. AlarmResistance Exhaustion

Stress and Illness § General Adaptation Syndrome § Selye’s concept of the body’s adaptive response to stress in three stages § General Adaptation Syndrome § Selye’s concept of the body’s adaptive response to stress in three stages Stress resistance Phase 1 Alarm reaction (mobilize resources) Phase 2 Resistance (cope with stressor) Phase 3 Exhaustion (reserves depleted) The body’s resistance to stress can last only so long before exhaustion sets in Stressor occurs

Stressful Life Events § Catastrophic Events § earthquakes, combat stress, floods § Life Changes § death of a loved one, divorce, loss of job, promotion § Daily Hassles § rush hour traffic, long lines, job stress, § Burnout-- physical, emotional, and mental exhaustion brought on by persistent job-related stress § Catastrophic Events § earthquakes, combat stress, floods § Life Changes § death of a loved one, divorce, loss of job, promotion § Daily Hassles § rush hour traffic, long lines, job stress, § Burnout-- physical, emotional, and mental exhaustion brought on by persistent job-related stress

Some Psychological Stressors for High School Students Life EventStress Points Divorce of parents98 Expulsion from school79 Major injury or illness77 Getting a job62 Major illness of close friend56 Peer difficulties45 Moving away41 Christmas30 Vacation25 Traffic ticket22

Perceived Control  Our personal control and optimism is related to stress and our immune system.  With loss of perceived control, we are vulnerable to ill health.  Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.  Our personal control and optimism is related to stress and our immune system.  With loss of perceived control, we are vulnerable to ill health.  Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.

Perceived Control § Health consequences of a loss of control No connection to shock source To shock controlTo shock source “Executive” rat“Subordinate” ratControl rat

Poverty and Inequality  Poorer people are more at risk for premature death.  People also tend to die younger in areas where there is greater income inequality.  People at every income level are at greater risk of death if they live in a community with great income inequality.  Poorer people are more at risk for premature death.  People also tend to die younger in areas where there is greater income inequality.  People at every income level are at greater risk of death if they live in a community with great income inequality.

Perceived Control § Equality and Longevity

Stress and the Heart § Coronary Heart Disease § clogging of the vessels that nourish the heart muscle § leading cause of death in many developed countries § Coronary Heart Disease § clogging of the vessels that nourish the heart muscle § leading cause of death in many developed countries

Stress, Personality, & Heart Disease  Coronary heart disease is North America’s leading cause of death  Habitually grouchy people tend to have poorer health outcomes  Chronic negative emotions have negative effect on immune system  Coronary heart disease is North America’s leading cause of death  Habitually grouchy people tend to have poorer health outcomes  Chronic negative emotions have negative effect on immune system

6 factors that increase the risk of heart disease:  1. Smoking  2. Obesity  3. High fat diet  4. Physical Inactivity  5. Elevated blood pressure  6. Elevated Cholesterol + stress and personality  1. Smoking  2. Obesity  3. High fat diet  4. Physical Inactivity  5. Elevated blood pressure  6. Elevated Cholesterol + stress and personality

Stress and the Heart Hopelessness scores Heart attack Death Low riskModerate riskHigh risk Men who feel extreme hopelessness are at greater risk for heart attacks and early death

Stress and the Heart § Type A § Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people § Type B § Friedman and Rosenman’s term for easygoing, relaxed people § Type A § Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people § Type B § Friedman and Rosenman’s term for easygoing, relaxed people

Research on type A Personality  Time urgency & competitiveness not associated with poor health outcomes  Negative emotions, anger, aggressive reactivity  High levels of hostility increase chance of all disease (e.g., cancer)  Time urgency & competitiveness not associated with poor health outcomes  Negative emotions, anger, aggressive reactivity  High levels of hostility increase chance of all disease (e.g., cancer)

Explanatory style  Optimism  use external, unstable, & specific explanations for negative events  predicts better health outcomes  Pessimism  use internal, stable, & global explanations for negative events  predicts worse health outcomes  Optimism  use external, unstable, & specific explanations for negative events  predicts better health outcomes  Pessimism  use internal, stable, & global explanations for negative events  predicts worse health outcomes

Stress and the Heart

Stress and Disease § Psychophysiological Illness § “mind-body” illness § any stress-related physical illness § some forms of hypertension § some headaches § distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease § Psychophysiological Illness § “mind-body” illness § any stress-related physical illness § some forms of hypertension § some headaches § distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease

Stress and Disease § Lymphocytes § two types of white blood cells that are part of the body’s immune system § B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections § T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances § Lymphocytes § two types of white blood cells that are part of the body’s immune system § B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections § T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances

 Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.

Stress and Disease § Conditioning of immune suppression UCS (drug) UCR (immune suppression) UCS (drug) UCR (immune suppression) CS (sweetened water) CS (sweetened water) CR (immune suppression)

Conflict Conflict arises when a person needs to decide between two alternatives. Types of conflict: Approach - Approach Avoidance - Avoidance Approach - Avoidance Double Approach - Avoidance

Approach-Approach The person is attracted to two goals. The approach - approach conflict is not all bad. You have to decide between two attractive choices.

Approach - Avoidance The person is attracted to one goal but it comes with a negative aspect. The approach - avoidance conflict can be distressing.

Avoidance - Avoidance The person has to choose between them. The avoidance - avoidance conflict presents two undesirable goals.

Double Approach - Avoidance The person has two goals, each has both good and bad characteristics. The double approach - avoidance conflict is the most common.

Stress and Disease § Negative emotions and health-related consequences Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Persistent stressors and negative emotions Release of stress hormones Heart disease Immune suppression Autonomic nervous system effects (headaches, hypertension)

Promoting Health § Aerobic Exercise § sustained exercise that increases heart and lung fitness § Aerobic Exercise § sustained exercise that increases heart and lung fitness Depression score Before treatment evaluation After treatment evaluation No-treatment group Aerobic exercise group Relaxation treatment group

Why Does Exercise Work?  Exercise and Mood  Releases chemicals  -- norepinephrine  -- serotonin  -- endorphins  Sense of accomplishment  Improved physique  Exercise and Mood  Releases chemicals  -- norepinephrine  -- serotonin  -- endorphins  Sense of accomplishment  Improved physique

Why Does Exercise Work?  Exercise and Health  Strengthens heart  Lowers blood pressure  Lowers blood pressure reactivity to stress  Moderate exercise adds two years to one’s expected life.  Exercise and Health  Strengthens heart  Lowers blood pressure  Lowers blood pressure reactivity to stress  Moderate exercise adds two years to one’s expected life.

Promoting Health § Biofeedback § system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state § blood pressure § muscle tension § Biofeedback § system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state § blood pressure § muscle tension

Biofeedback  Feedback about subtle bodily responses  e.g., tension in forehead  Not controlling body’s responses  People can influence some of these responses  finger temperature  forehead tension  Reduce intensity of migraines  Help with some chronic pain  Relaxation crucial to biofeedback success  Feedback about subtle bodily responses  e.g., tension in forehead  Not controlling body’s responses  People can influence some of these responses  finger temperature  forehead tension  Reduce intensity of migraines  Help with some chronic pain  Relaxation crucial to biofeedback success

Promoting Health § Modifying Type A life-style can reduce recurrence of heart attacks Percentage of patients with recurrent heart attacks (cumulative average) Year Life-style modification patients Control patients Modifying life-style reduced recurrent heart attacks

Relaxation  Meditation can lower blood pressure, heart rate, oxygen consumption  Can it help with stress-related disease?  Meditation can lower blood pressure, heart rate, oxygen consumption  Can it help with stress-related disease?

Social Support  Feeling liked, affirmed, and encouraged by intimate friends and family-- promotes happiness and health.  Social support calms the cardiovascular system and lowers stress hormones.  Feeling liked, affirmed, and encouraged by intimate friends and family-- promotes happiness and health.  Social support calms the cardiovascular system and lowers stress hormones.

Promoting Health § Social support across the life span Age in years 100% Percentage with high support

Life events Tendency toward Health Illness Personal appraisal Challenge Threat Personality type Easy going Nondepressed Optimistic Hostile Depressed Pessimistic Personality habits Nonsmoking Regular exercise Good nutrition Smoking Sedentary Poor nutrition Level of social support Close, enduringLacking

Spirituality & Faith Communities  Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.  Those who attend religious services experience lower death rates from coronary heart disease.  Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.  Those who attend religious services experience lower death rates from coronary heart disease.

Promoting Health § Religious Attendance

Promoting Health § Predictors of mortality Men Women Not smoking Regular exercise Weekly religious attendance Relative risk of dying

Promoting Health § The religion factor is mulitidimensional Religious involvement Healthy behaviors (less smoking, drinking) Social support (faith communities, marriage) Positive emotions (less stress, anxiety) Better health (less immune system suppression, stress hormones, and suicide)

Promoting Health § Complementary and Alternative Medicine § unproven health care treatments not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies § Complementary and Alternative Medicine § unproven health care treatments not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies

Alternative systems of medical practice Bioelectromagnetic Applications Diet, nutrition, life-style changes Herbal medicine Manual healing Mind-body control Pharmacological and biological treatments Subfields of Alternative Medicine Health care ranging from self-care according to folk principles, to care rendered in an organized health care system based on alternative traditions or practices The study of how living organisms interact with electromagnetic (EM) fields The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention Employing plan and plant products from folk medicine traditions for pharmacological use Using touch and manipulation with the hands as a diagnostic and therapeutic tool Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected- ness of mind and body Drugs and vaccines not yet accepted by mainstream medicine

Promoting Health § Smoking-related early deaths 40,000 30,000 20,000 10, ,348 1,6861, Smoking Suicide Vehicle HIV/ Homicide crash AIDS Cause of death Number of deaths per 100,000

The Physiological Effects of Nicotine

Promoting Health § Fewer Canadian smokers Males Females Year 60% Percentage of Canadians smoking

Smoking Prevention § U.S. teen smoking

Smoking Prevention § Results of a smoking inoculation program Percentage of students who smoke Seventh gradeEighth gradeNinth grade Months of study Control school School with smoking Prevention program Fewer teens took up smoking when “inoculated” against it

 “You are what you eat”. Eating foods that provide the biochemical building blocks for those neurotransmitters affect our mood and behavior. People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.

Obesity & Weight Control § Obesity and body mass index

Obesity and Weight Control § Obesity and mortality Body-mass index (BM I) MenWomen Relative risk of death

Weight Discrimination § When women applicants were made to look overweight, subjects were less willing to hire Willingness to hire scale (from1: definitely not hire to 7: definitely hire ) WomenMen NormalOverweight

Weight Control § Effects of a severe diet Caloric intake in calories per day Body weight in kilograms Metabolism: Oxygen consumption in liters per hour Days Days

Weight Control § Trading risks

Weight Control § Thinning of Miss America

Weight Control § Most lost weight is regained Weight change in pounds Post treatment Years of follow-up Starting point Normal trend for untreated obese people: Gradually rising weight After participation in behavioral Program: Much of initial weight loss regained

Weight Control § Obesity was more common among those who watched the most television 4 Hours of television watched per day in 1990s study BoysGirls Skinfold fat measure (mm)

The Physiology of Obesity  Fat Cells  A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.  Fat Cells  A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.

Set points and Metabolism  Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.  Metabolism is the rate at which we burn calories.  Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.  Metabolism is the rate at which we burn calories.

The Genetic Factor  There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.  Rather, people’s weights resemble those of their biological parents.  Identical twins have closely similar weights, even when reared apart.  There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.  Rather, people’s weights resemble those of their biological parents.  Identical twins have closely similar weights, even when reared apart.

Losing Weight  Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.  Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.  Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.  Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.

HELPFUL HINTS FOR LOSING WEIGHT Minimize exposure to tempting food cues Take steps to boost your metabolism Be Realistic and Moderate Modify both your metabolic rate and your hunger by changing the food you eat. Don’t starve all day and eat one big meal at night. Beware of the binge. Set realistic goals. Minimize exposure to tempting food cues Take steps to boost your metabolism Be Realistic and Moderate Modify both your metabolic rate and your hunger by changing the food you eat. Don’t starve all day and eat one big meal at night. Beware of the binge. Set realistic goals.