1. Chapter 7 Physical Disorders and Health Psychology

2. 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

3. Psychological and Social Factors that Influence Health 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

5. 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

6. 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

7. Overview of Stress and the Stress Response The stress response and the general adaptation syndrome (GAS) – Phase 1 – alarm response (sympathetic arousal) – Phase 2 – resistance (mobilized coping and action) – Phase 3 – exhaustion (chronic stress, permanent damage)

8. Physiology of Stress The biology of stress – Activates the sympathetic branch of the ANS – Neuromodulators and neuropeptides act like neurotransmitters – Activates the HPA axis, producing cortisol – The relation between the hippocampus and HPA activation

9. Physiology of Stress 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

10. Stress, Anxiety, and Excitement 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

11. Stress, Anxiety, and Excitement 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

13. Stress and the Immune Response 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

16. Stress and the Immune System: The Role of Leukocytes Leukocytes: subtypes and functions – Macrophages First line of defense, destroy antigens, signal lymphocytes – 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

17. Stress and the Immune System: The Role of Leukocytes Stress dramatically and quickly alters immune function Autoimmune disease Rheumatoid arthritis Psychoneuroimmunology (PNI)

18. Acquired Immunodeficiency Virus (AIDS) Nature of AIDS – 33.4 million cases in 2008 – 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 – AIDS-related complex (ARC) – HAART

19. Acquired Immunodeficiency Virus (AIDS) 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

20. 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)

21. Cancer: Psychological and Social Influences – Overwhelming, stressful life events – Lifestyle risk behaviors – Psychological factors also are involved in chemotherapy Cancer is influenced by psychological, behavioral, and social factors

22. Breast Cancer Support and Education Women with… – low self-esteem – low body image, – feelings of low control – low optimism – a lack of support at home …were even more likely to benefit from an education intervention

23. 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

24. Cardiovascular Problems: Hypertension Contributing factors and associated features – Affects 27.6% of all adults (between ages of 35 and 64) – 29% for everyone over 18 years – 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

26. 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) – Ischemia Deficiency of blood supply because of too much plaque – Myocardial infarction Heart attack involving death of heart tissue

27. Cardiovascular Diseases: CHD Psychological and behavioral risk factors for CHD – Stress, anxiety, anger, – Poor coping skills – Low social support – Lifestyle factors (e.g., smoking, diet, exercise) – Classic type A behavior pattern Anger and negative affect Impatience, accelerated speech and motor activity

28. Cardiovascular Diseases: CHD The role of chronic negative emotions CHD is influenced by psychological, behavioral, and social factors

29. Chronic Pain Acute vs. chronic pain – Acute pain vs. chronic pain – Severity of pain does not predict one’s reaction to it Pain: Some clinical distinctions – Subjective vs. overt behavioral manifestations of pain

30. Chronic Pain Psychological and social aspects of 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 opioids

31. Chronic Pain Biological aspects of pain – Gate control theory: An integrative account – The role of endogenous opioids – Gender differences in pain

32. 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

33. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences Speculation about causes – High-achievement oriented lifestyle – Fast paced lifestyle combines with stress and illness – Psychological misinterpretation of consequences of illness

35. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influence Treatment – Medications are ineffective – Cognitive-behavioral interventions appear promising

36. 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)

38. Psychosocial Treatment of Physical Disorders Comprehensive stress reduction and pain management programs – More effective and durable than individual interventions alone – Drugs and Stress-reduction programs – Denial as a means of coping

39. Modifying Behaviors to Promote Health Lifestyle practices – core of many health problems – Behavioral risk factors are also influenced by psychosocial factors – Prevention and intervention programs target behavioral risks

40. Modifying Behaviors to Promote Health Types of lifestyle behaviors – Injury and injury prevention Repeated warnings are not enough – AIDS prevention Highly preventable by changing behaviors – Diet, exercise, promotion of health and wellness – Stanford Three Community Study

41. 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

42. Summary of Physical Disorders and Health Psychology Risk for physical illness – Related to long-standing patterns of behavior & lifestyle factors Psychosocial treatments – Aim to prevent and/or treat physical disorders – Comprehensive individual or community programs are best

43. DSM-5 Proposed Changes http://www.dsm5.org/ProposedRevisions/Pag es/OtherClinicalConditionsThatMayBeaFocuso fClinicalAttention.aspx http://www.dsm5.org/ProposedRevisions/Pag es/OtherClinicalConditionsThatMayBeaFocuso fClinicalAttention.aspx