Health Psychology & Behavioral Medicine Health psychology Studies the relationship between psychological factors and physical health Health psychology Studies the relationship between psychological factors and physical health Behavioral Medicine (not Psych) Interdisciplinary field integrating behavioral and medical knowledge Behavioral Medicine (not Psych) Interdisciplinary field integrating behavioral and medical knowledge Health Psych Division 38 Health Psych Division 38

Health Psychology True or False Half the mortality from the 10 leading causes of death is due to people’s behavior Half the mortality from the 10 leading causes of death is due to people’s behavior People tend to die younger in areas where there is greater income inequality People tend to die younger in areas where there is greater income inequality Compared to others, pessimists are more than twice as likely to develop heart disease Compared to others, pessimists are more than twice as likely to develop heart disease Writing about personal traumas in a diary reduces stress and the likelihood of health problems Writing about personal traumas in a diary reduces stress and the likelihood of health problems Religious faith and health show a strong positive correlation Religious faith and health show a strong positive correlation Smoking a cigarette takes 12 minutes off one’s life expectancy Smoking a cigarette takes 12 minutes off one’s life expectancy Genes influence one’s propensity to cigarette addiction Genes influence one’s propensity to cigarette addiction

Leading Causes of Death 1900 and 2000

Health and Stress Stress A state of psychological tension or strain where we respond to stressors that we appraise as threatening or challenging. Distress and Eustress Stressors Events or circumstances that trigger stress Adjustment Any attempt to cope with stress

Sources of Distress Everyday Hassles – Specific examples? Everyday Hassles – Specific examples? Pressure Pressure Frustration Frustration Discrimination* Discrimination* Conflict* Conflict* Extreme Events and Stress Extreme Events and Stress Bereavement and loss Bereavement and loss Unemployment Unemployment Divorce and separation Divorce and separation Catastrophes Catastrophes Combat Combat

Sources of Stress Major life changes – Social Readjustment Rating Scale (SRRS) [Holmes & Rahe] Major life changes – Social Readjustment Rating Scale (SRRS) [Holmes & Rahe] Assesses impact of major life changes Assesses impact of major life changes Problems: Adult oriented. Fails to account for different contexts. Cross-cultural limitations Problems: Adult oriented. Fails to account for different contexts. Cross-cultural limitations SRSS online SRSS online SRSS online SRSS online Undergraduate scale Undergraduate scale Undergraduate scale Undergraduate scale H&R Non-Adult Life Event Scale H&R Non-Adult Life Event Scale H&R Non-Adult Life Event Scale H&R Non-Adult Life Event Scale

Daily Hassles: Approach-Avoidance Opposing Tendencies (Lewin) Four types of approach- avoidance conflicts Opposing Tendencies (Lewin) Four types of approach- avoidance conflicts Approach/Approach conflict – When a person is simultaneously attracted to two appealing goals. Conflict arises from choice Approach/Approach conflict – When a person is simultaneously attracted to two appealing goals. Conflict arises from choice Avoidance/Avoidance – When a person is facing two undesirable or threatening choices. “A rock and a hard place” scenario Avoidance/Avoidance – When a person is facing two undesirable or threatening choices. “A rock and a hard place” scenario Approach/Avoidance – A person is simultaneously attracted to and repelled by the same situation. Mmmm…cheesecake, fattening Approach/Avoidance – A person is simultaneously attracted to and repelled by the same situation. Mmmm…cheesecake, fattening Multiple Approach/Avoidance – Several alternative courses of action with many promising an distressing aspects, e.g. get job or go to grad school Multiple Approach/Avoidance – Several alternative courses of action with many promising an distressing aspects, e.g. get job or go to grad school

Extreme Stress: Psychological Consequences Post-Traumatic Stress Disorder (PTSD) Post-Traumatic Stress Disorder (PTSD) Episodes of anxiety, recurrence, sleepless- ness, and nightmares Episodes of anxiety, recurrence, sleepless- ness, and nightmares Victims may withdraw from social life, job and/or family responsibilities Victims may withdraw from social life, job and/or family responsibilities Depression and suicide Depression and suicide

Stress and the Role of Appraisal “Psychological stress resides neither in the situation nor the person; it depends on the transaction between the two. It arises from how the person appraises an event and adapts to it. (Lazarus…Remember him?)” Stress impact depends on frequency, duration and intensity as well as personality, coping style and events of the day

Locus and Loss of Control Catastrophic events, major life changes, daily hassles and conflicts are especially stressful when perceived as uncontrolled Catastrophic events, major life changes, daily hassles and conflicts are especially stressful when perceived as uncontrolled Changes in workplace and nursing home settings (Rodin) that increase control result in less stress, illness and reported higher life satisfaction Changes in workplace and nursing home settings (Rodin) that increase control result in less stress, illness and reported higher life satisfaction Discovering Psych - Health Discovering Psych - Health Discovering Psych - Health Discovering Psych - Health

Pessimism and Heart Disease Pessimistic adult men are twice as likely to develop heart disease over a 10-year period (Kubzansky et al., 2001)

Optimistic Explanatory Style Those with optimistic (instead of pessimistic) explanatory styles tend to have more control over stressors, cope better with stressful events, have better moods, and have stronger immune systems

Stress and Individual Differences Hardiness A characteristic of people who can tolerate stress well or even thrive on it Hardiness A characteristic of people who can tolerate stress well or even thrive on it Resilience Ability of a person to “bounce back” after a stressful event (Resiliency theory) Resilience Q Resilience Ability of a person to “bounce back” after a stressful event (Resiliency theory) Resilience QResilience QResilience Q Self-imposed stress People who have irrational, self-defeating beliefs that add unnecessarily to the normal stresses of living Self-imposed stress People who have irrational, self-defeating beliefs that add unnecessarily to the normal stresses of living

Socioeconomic and Gender Differences Research findings Lower socioeconomic status can predict more stressful environments and fewer psychological resources for dealing with stress Lower socioeconomic status can predict more stressful environments and fewer psychological resources for dealing with stress Women and men seem to be equally affected by stress physiologically, but deal with it differently – role of ). Women deal more effectively Women and men seem to be equally affected by stress physiologically, but deal with it differently (tend and befriend) – role of oxytocin). Women deal more effectively.

Types of Stress Response Life events Tendency toward HealthIllness Personal appraisal ChallengeThreat 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

Stress and Health: Type A and B (and D) Personalities Type A Competitive, hard-driving (Friedman and Rosenman). Correlates with heart disease, though this is Primarily due to 1) negative emotions (anger and hostility) and 2) associated behaviors (impatience, verbal aggressiveness, and anger) Type A Competitive, hard-driving (Friedman and Rosenman). Correlates with heart disease, though this is Primarily due to 1) negative emotions (anger and hostility) and 2) associated behaviors (impatience, verbal aggressiveness, and anger) Type B More easygoing, relaxed people Type B More easygoing, relaxed people Type D Emotionally distressed people. Often characterized by social withdrawal. Correlates with higher rates of stress, disease and death Type D Emotionally distressed people. Often characterized by social withdrawal. Correlates with higher rates of stress, disease and death

Stress Reaction General Adaptation Syndrome (Hans Seyle) General Adaptation Syndrome (Hans Seyle) Alarm reaction (sympathetic arousal-need to fight off physical or psychological threats – Cannon’s ). Epinephrine Alarm reaction (sympathetic arousal-need to fight off physical or psychological threats – Cannon’s fight or flight). Epinephrine Adaptation/Resistance (effort to maintain high level of resistance-attempts to maintain psychological equilibrium. Corticosteroid production. Adaptation/Resistance (effort to maintain high level of resistance-attempts to maintain psychological equilibrium. Corticosteroid production. Exhaustion (depletion of reserves) Exhaustion (depletion of reserves) The body is designed to cope with temporary stress; prolonged stress leads to physical deterioration due to destructive levels of corticosteroids (cortisol) The body is designed to cope with temporary stress; prolonged stress leads to physical deterioration due to destructive levels of corticosteroids (cortisol) Parasympathetic rebound can lead to death

Selye’s GAS 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

The Biology of Stress GAS GAS and the Fight or flight response (Cannon) Hypothalamus directs pituitary to release epinephrine into the bloodstream Hypothalamus directs pituitary to release epinephrine into the bloodstream Complex of sympathetic arousal: Increased heart rate, respiration, blood from digestion to muscles, masks pain, releases sugar and fat from body’s stores to deal with stress. Complex of sympathetic arousal: Increased heart rate, respiration, blood from digestion to muscles, masks pain, releases sugar and fat from body’s stores to deal with stress. Parasympathetic rebound can lead to death Release of (stress hormone) from outer part of adrenal gland (it’s how we measure stress) Release of cortisol/corticosterones (stress hormone) from outer part of adrenal gland (it’s how we measure stress) Stress Effects HW Stress Effects HW Stress Effects HW Stress Effects HW

Stress and Disease Psycho-physiological illness Stress-related physical illness Psycho-physiological illness Stress-related physical illness Some hypertension, headaches, and gastrointestinal issues Some hypertension, headaches, and gastrointestinal issues Distinct from misinterpreting normal physical sensations as symptoms of a disease Distinct from hypochondriasis = misinterpreting normal physical sensations as symptoms of a disease Psycho-neuroimmunological disease Interaction between stress and the immune, endocrine, and nervous systems Psycho-neuroimmunological disease Interaction between stress and the immune, endocrine, and nervous systems Chronic stress can suppress immune function. Role of cortisol Chronic stress can suppress immune function. Role of cortisol (lymphocytes) Possible link between stress and cancer Possible link between stress and cancer

Stress and the Immune System  B lymphocytes fight bacterial infections  T lymphocytes attack cancer cells and viruses  Microphages ingest foreign substances  During stress, energy is mobilized away from the immune system making us vulnerable

The Brain on Stress The damaging (and helpful) effects of stress on the brain and cognition (hippocampus & cortisol, emotions and memory, brain-blood barrier, brain degeneration…) The damaging (and helpful) effects of stress on the brain and cognition (hippocampus & cortisol, emotions and memory, brain-blood barrier, brain degeneration…) The Human Brain – Stress The Human Brain – Stress The Human Brain – Stress The Human Brain – Stress Resource: The Brain: Teaching Modules Resource: The Brain: Teaching Modules Resource: The Brain: Teaching Modules Resource: The Brain: Teaching Modules Stress and Memory Stress and Memory Stress and Memory Stress and Memory

Direct Coping Direct/Proactive coping Use of intentional methods to address stress Confrontation/Compromise/Withdrawal Anticipate stressful events and take steps to avoid them Positive reappraisal (again, Lazarus) Alter the way you think about a stressful situation or make the best of a tense or stressful event. Importance of humor

Defensive Coping Defensive coping Occurs when one cannot identify the source of stress or do anything to change the situation Use of self-deceptive techniques known as to reduce stress. Types include denial, repression, projection, regression, reaction formation, displacement, and sublimation Use of self-deceptive techniques known as defense mechanisms to reduce stress. Types include denial, repression, projection, regression, reaction formation, displacement, and sublimation

Methods of Reducing Stress Calm down Calm down Exercise and healthy lifestyle Exercise and healthy lifestyle Relaxation training () Relaxation training (biofeedback) Meditation Meditation Reach out Reach out Social support network Social support network Religion Religion Studies have shown an association between religion and lower stress levels Studies have shown an association between religion and lower stress levels Altruism Altruism Giving to others (do good…) Giving to others (do good…) Shown to be a good way to reduce stress Shown to be a good way to reduce stress

Biofeedback, Relaxation, and Meditation Biofeedback systems use electronic devices to inform people about their physio- logical responses and gives them the chance to bring their response to a healthier range Relaxation and meditation have similar effects in reducing tension and anxiety Biofeedback systems use electronic devices to inform people about their physio- logical responses and gives them the chance to bring their response to a healthier range (Neal Miller). Relaxation and meditation have similar effects in reducing tension and anxiety

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) The Religion Factor

Why Do People Smoke?  Social rewards  Genetic factors  Smoking/Nicotine removes unpleasant cravings (aka negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins  Nicotine itself is rewarding (positive reinforcement)

Genetic Factors in Obesity Identical (MZ) twin studies reveal that body weight has a genetic basis The obese mouse on the left has a defective gene for the hormone leptin. The mouse on the right sheds 40% of its weight when injected with leptin