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 (continued)
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

4. 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

5. 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

6. Overview of Stress and the Stress Response (continued)
The Stress Response and the General Adaptation Syndrome
Phase 1 – Alarm response (sympathetic arousal)
Phase 2 – Resistance (mobilized coping and action)
Phase 3 – Exhaustion (chronic stress, permanent damage)

7. Physiology of Stress
The Biology of Stress
Activates the sympathetic branch of the ANS
Activates the HPA axis, producing cortisol

8. Physiology of Stress (continued)
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

9. Psychological and Social Factors: Their Relation to Stress Physiology
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

10. Psychological and Social Factors: Their Relation to Stress Physiology (continued)
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

11. Stress and the Immune System
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

12. Figure 7.3 An overview of the immune system
Fig. 7.3, p. 269

13. Stress and the Immune System: The Role of Leukocytes
Leukocytes: Subtypes and Functions
Macrophages
First line of defense, destroy antigens, signal lymphocytes

14. Stress and the Immune System: The Role of Leukocytes (continued)
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
Stress Dramatically and Quickly Alters Immune Function

15. Acquired Immunodeficiency Virus (AIDS)
Nature of AIDS
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

16. Acquired Immunodeficiency Virus (AIDS) (continued)
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

17. 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)

18. Cancer: Psychological and Social Influences
Overwhelming stressful life events
Life-style risk behaviors
Psychological factors also are involved in chemotherapy
Cancer is Influenced by Psychological, Behavioral, and Social Factors

19. 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

20. Cardiovascular Problems: Hypertension (continued)
Contributing Factors and Associated Features
Affects 20% of all adults (between ages of 25 and 74)
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

21. Cardiovascular Diseases: 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)

22. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued
Ischemia
Deficiency of blood supply because of too much plaque
Myocardial infarction
Heart attack involving death of heart tissue

23. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued
Psychological and Behavioral Risk Factors for CHD
Stress, anxiety, anger,
Poor coping skills
Low social support
Lifestyle factors (e.g., smoking, diet, exercise)

24. Cardiovascular Diseases: Coronary Heart Disease (CHD) -continued
Classic Type A Behavior Pattern
Anger and negative affect
Impatience, accelerated speech and motor activity
CHD Is Influenced by Psychological, Behavioral, and Social Factors

25. 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

26. Chronic Pain (continued)
Psychological and Social Factors in Chronic 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 Opiods

27. 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

28. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences (continued)
Speculation About Causes
High-achievement oriented lifestyle
Fast paced lifestyle combines with stress and illness
Psychological misinterpretation of consequences of illness

29. Chronic Fatigue Syndrome: Psychological, Behavioral, and Social Influences (continued)
Treatment
Medications are ineffective
Cognitive-behavioral interventions appear promising

30. 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)

31. Psychosocial Treatment of Physical Disorders (continued)
Comprehensive Stress Reduction and Pain Management Programs
More effective and durable than individual interventions alone

32. Modifying Behaviors to Promote Health
Life-Style Practices – Core of Many Health Problems
Behavioral risk factors are also influenced by psychosocial factors
Prevention and intervention programs target behavioral risks

33. Modifying Behaviors to Promote Health (continued)
Types of Life-Style Behaviors
Injury and injury prevention
Repeated warnings are not enough
AIDS
Highly preventable by changing behaviors
China and smoking cessation programs
Diet, exercise, promotion of health and wellness
Stanford three community study

34. 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

35. Summary (continued)
Risk for Physical Illness
Related to long-standing patterns of behavior & life-style factors
Psychosocial Treatments
Aim to prevent and/or treat physical disorders
Comprehensive individual or community programs are best