1. “Your One and Only Car”

3. Behavioral Medicine
Centers for Disease Control (CDC) claim that half of the deaths in the US are due to people’s behaviors (smoking, alcoholism, unprotected sex, insufficient exercise, drugs, and poor nutrition).

4. Behavioral Medicine
Psychologists and physicians have thus developed an interdisciplinary field of behavioral medicine that integrates behavioral knowledge with medical knowledge, and applies that knowledge to health and disease

5. Health Psychology
Health psychology is a field of psychology that contributes to behavioral medicine. The field studies stress-related aspects of disease and asks the following questions:
How do emotions and personality factors influence the risk of disease?
What attitudes and behaviors prevent illness and promote health and well-being?
How do our perceptions determine stress?
How can we reduce or control stress?

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

7. Stress Psychological states cause physical illness.
Stress is any circumstance (real or perceived)
that threatens a person’s well-being.
OBJECTIVE 1| List four leading causes of death and describe health psychology’s contribution to the field of behavioral medicine.
Lee Stone/ Corbis
When we feel severe stress, our ability to cope with it is impaired.

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

9. Stress
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.

11. THE DOLPHIN STRESS TEST
Below is a picture of two dolphins.
If you can see both dolphins, your stress
level is within the acceptable range.
If you see anything
other than two
dolphins, your stress
level is too high and
you need to stay
home and rest.

13. And You Think You Have Stress…

14. Stress and Stressors Stress is a slippery concept.
At times it is the stimulus (missing an appointment) and at other times it is a
response (sweating while taking a test).
OBJECTIVE 2| Discus the importance of appraisal in the way we respond to stressful events.

15. Stress and Stressors
Stress is not merely a stimulus or a response. It is a process by which we appraise and cope with environmental threats and challenges.
When short-lived or taken as a challenge, stressors may have positive effects. However, if stress is threatening or prolonged, it can be harmful.

16. The Stress Response System
Canon proposed that the stress response (fast) was a fight-or-flight response marked by the outpouring of epinephrine and norepinephrine from the inner adrenal glands, increasing heart and respiration rates, mobilizing sugar and fat, and dulling pain.
OBJECTIVE 3| Identify and describe the dual-track system by which our body responds to stress, and give the three phases of the general adaptation syndrome.

17. The Stress Response System
The hypothalamus and the pituitary gland also respond to stress (slow) by triggering the outer adrenal glands to secrete glucocorticoids (cortisol).

18. Fight or Flight (Walter Cannon)
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.

19. 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.
Alarm
Resistance
Exhaustion
3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

20. General Adaptation Syndrome
According to Selye, a stress response to any kind of
stimulation is similar. The stressed individual goes
through three phases.
EPA/ Yuri Kochetkov/ Landov

21. Major disasters are just one of about a half-dozen types of calamitous events that can lead to posttraumatic stress disorder.
p. 527

22. Stressful Life Events Catastrophic Events Life Changes Daily Hassles
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

24. Some Psychological Stressors for High School Students
Life Event Stress Points
Divorce of parents 98
Expulsion from school 79
Major injury or illness 77
Getting a job
Major illness of close friend 56
Peer difficulties 45
Moving away
Christmas
Vacation
Traffic ticket

26. Significant Life Changes
The death of a loved one, a divorce, a loss of job, or a promotion may leave individuals vulnerable to disease.

27. 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.

28. Perceived Control Health consequences of a loss of control
No connection
to shock source
To shock control
To shock source
“Executive” rat
“Subordinate” rat
Control rat

29. 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.

30. Stress and the Heart
Stress that leads to elevated blood pressure may result in Coronary Heart Disease, a clogging of the vessels that nourish the heart muscle.
Plaque in
coronary artery
Artery
clogged
OBJECTIVE 5| Discuss the role of stress in causing coronary heart disease, and contrast Type A and Type B personalities.

31. 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

32. 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

33. Stress and the Heart Hopelessness scores Heart attack Death 3.5 3 2.5
1.5 1
0.5
Heart attack
Death
Low risk
Moderate risk
High risk
Men who feel extreme hopelessness
are at greater risk for heart attacks
and early death

34. Stress and the Heart Type A Type B
Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people. Type A personalities are more likely to develop coronary heart disease.
Type B
Friedman and
Rosenman’s term
for easygoing, relaxed people

35. Type A Personality

36. Type B Personality

37. 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)
graph from Hockenbury text, figure 13.5, taken from CD Rom

38. Explanatory style Optimism Pessimism
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

39. Stress and the Heart

40. 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

41. 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

42. Stress and the Immune System
B lymphocytes fight bacterial infections, T lymphocytes attack cancer cells and viruses, and microphages ingest foreign substances. During stress, energy is mobilized away from the immune system making it vulnerable.
OBJECTIVE 7| Describe the effect of stress on immune system functioning.
Lennart Nilsson/ Boehringer Ingelhein International GmbH

43. 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.

44. Stress and AIDS
Stress and negative emotions may accelerate the progression from human immunodeficiency virus (HIV) to acquired immune deficiency syndrome (AIDS).
OBJECTIVE 8| Discuss the findings on the link between stress and AIDS.
UNAIDS/ G. Pirozzi

45. Stress and Cancer Stress does not create cancer cells.
Researchers disagree on whether stress
influences the progression of cancer.
However, they do agree that avoiding stress
and having a hopeful attitude
cannot reverse advanced cancer.
OBJECTIVE 9| Discuss the findings on the link between stress and cancer.

46. Stress and Immune Conditioning
If the immune system can be suppressed through conditioning, researchers believe that immune- enhancing responses can be inculcated to combat viral diseases.
OBJECTIVE 10| Describe the impact of learning on immune system functioning.

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

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

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

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

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

52. poor nutrition and sleep)
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)

53. Promoting Health
Promoting health is generally defined as the absence of disease.
We only think of health when we are diseased. However, health psychologists say that promoting health begins by preventing illness and enhancing well-being, which is a constant endeavor.

54. Coping with Stress
Reducing stress by changing events that cause stress or by changing how we react to stress is called problem-focused coping.
Emotion-focused coping is when we cannot change a stressful situation, and we respond by attending to our own emotional needs.
OBJECTIVE 11| Explain what it means to cope with stress, and contrast problem-focused coping and emotion-focused coping.

55. Explanatory Style
People with an optimistic (instead of pessimistic) explanatory style tend to have more control over stressors, cope better with stressful events, have better moods, and have a stronger immune system.
OBJECTIVE 13| Discuss the links among explanatory style, stress and health.

56. Promoting Health Aerobic Exercise
Depression
score 14 13 12 11 10 9 8 7 6 5 4 3
Before treatment
evaluation
After treatment
No-treatment
group
Aerobic
exercise
Relaxation
treatment
Aerobic Exercise
sustained exercise that increases heart and lung fitness

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

58. 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.

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

60. 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

61. Life-Style
Modifying a Type-A lifestyle may reduce the recurrence of heart attacks.

62. Relaxation
Meditation can lower blood pressure, heart rate, oxygen consumption
Can it help
with
stress-related
disease?
figure from Myers taken from CD Rom

64. Social Support
Supportive family members, marriage partners, and close friends help people cope with stress. Their immune functioning calms the cardiovascular system and lowers blood pressure.
OBJECTIVE 14| Describe some of the ways that social support acts as a stress buffer.
Bob Daemmrich/ Stock, Boston

65. Managing Stress
Having a sense of control, an optimistic explanatory style, and social support can reduce stress and improve health.
OBJECTIVE 15| Explain the difference between coping with stress and managing stress.

66. 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.

67. Spirituality & Faith Communities
Regular religious attendance has been a reliable predictor of a longer life span with a reduced risk of dying.
OBJECTIVE 18| Discuss the correlation between religiosity and longevity, and offer some possible explanations for this link.

68. Intervening Factors
Investigators suggest there are three factors that connect religious involvement and better health.

69. Managing Stress: Summary
How can stress be managed?

70. 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

71. Subfields of Alternative Medicine
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

72. Promoting Health Smoking-related early deaths Number of deaths
40,000
30,000
20,000
10,000
33,348
1,686
1,135
556
202
Smoking Suicide Vehicle HIV/ Homicide
crash AIDS
Cause of death
Number
of deaths
per 100,000

73. Why Do People Smoke? People smoke because it is socially rewarding.
The elimination of smoking would increase life expectancy more than any other preventive measure.
People smoke because it is socially rewarding.
Smoking is also a result of genetic factors.

74. Why Do People Smoke?
Nicotine takes away unpleasant cravings (negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins.
Nicotine itself is rewarding (positive reinforcement).

75. Helping Smokers Quit
Smoking decreased in Western countries, especially in higher socioeconomic groups and more educated groups.
OBJECTIVE 20| Discuss ways of helping smokers to quit smoking – or preventing young people from ever starting.

76. Here are a few pointers on how to quit smoking:
Ways to Quit Smoking
Here are a few pointers on how to quit smoking:
Set a quit date.
Inform family and friends.
Throw away all cigarettes.
Review successful strategies.
Use a nicotine patch or gum.
Abstain from alcohol.
Exercise.

77. Prevention programs do have an effect on smoking.
Do Programs Work?
Prevention programs do have an effect on smoking.
Paul J. Milette/ Palm Beach Post

78. Smoking Abstinence Programs
Smoking abstinence programs for teens provide:
Information about the effects of smoking
Information about peer, parent & media influence
Ways to refuse cigarettes

79. Biopsychosocial Factors: Smoking

80. Obesity and Weight Control
Fat is an ideal form of stored energy and is readily available. In times of famine, an overweight body was a sign of affluence.
OBJECTIVE 21| Discuss the adaptive advantage of a body that stores fat.

81. “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.

82. Nutrition

83. Body Mass Index (BMI)
Obesity in children increases their risk of diabetes, high blood pressure, heart disease, gallstones, arthritis, and certain types of cancer, thus shortening their life-expectancy.

84. The death rate is high among very overweight men.
Obesity and Mortality
The death rate is high among very overweight men.

85. 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.

86. Physiology of Obesity
Fat Cells: There are million fat cells in the body. These cells can increase in size or increase in number (75 million) in an obese individual (Sjöstrum, 1980).
OBJECTIVE 23| Give arguments for and against the idea that genes determine body weight.

88. Weight Discrimination
Willingness
to hire scale
(from1:
definitely
not hire to
7: definitely
hire) 1 2 3 4 5 6 7
Women
Men
Normal
Overweight
When women applicants were made to look overweight, subjects were less willing to hire

89. 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.

90. Set Points and Metabolism
When reduced from 3,500 calories to 450 calories, weight loss was a minimal 6% and the metabolic rate a mere 15%.
The obese defend their weight by conserving energy.

91. 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.

92. 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.

93. Identical twin studies reveal that body weight has a genetic basis.
The Genetic Factor
Identical 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.

94. Activity
Lack of exercise is a major contributor to obesity. Just watching TV for two hours resulted in a 23% increase of weight when other factors were controlled.

95. Food Consumption
Over the past 40 years average weight gain has increased. Health professionals are pleading with US citizens to limit their food intake.

96. Plan to Lose Weight
When you are motivated to lose weight, begin a weight-loss program, minimize your exposure to tempting foods, exercise, and forgive yourself for lapses.

97. Trading Risks
Although cigarette smoking has declined over the years in the Americas, obesity is on the rise.

98. Weight Control
Thinning of Miss America

99. Weight Control Most lost weight is regained Weight change in pounds
-20
-15
-10 -5 5 10 1 2 3 4
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
Most lost weight is regained

100. Hours of television watched per day
Weight Control
< >4
Hours of television watched per day
in 1990s study
Boys
Girls 32 30 28 26 24 22 20
Skinfold fat
measure (mm)
Obesity was more common among those who watched the most television

103. 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.