1. Physical Disorders and Health Psychology

2. Psychological and Social Influences on Health
Contribute to top fatal diseases
50% of deaths from 10 leading causes of death in US can be linked to behavior

3. Behavioral medicine Health psychology Prevention, diagnosis, treatment
Interdisciplinary
Health psychology
Psychological factors important in promotion, maintenance of health
Health care policy

4. Ways Psychology Influences Health
Affect basic biological process that lead to illness
E.g stress and cardiovascular health
Influence risky behavior
Smoking
Alcohol
Nutrition

6. Selye’s General Adaptation Syndrome
Body’s response to sustained stress
Alarm
Resistance
Exhaustion

7. Stress and the Immune System
Early research on stress and cold viruses
Psychological impact on immune functioning
Depression has a direct effect?
Self care and risky behaviors

8. Psychological Effects on Physical Disorders
AIDS
Cancer
Cardiovascular Problems
Hypertension
Coronary Heart Disease
Chronic Pain
Chronic Fatigue Syndrome

9. AIDS 40 million worldwide live with AIDS (2003) Course variable
20-40% of pop’n in southern Africa
Course variable
Up to years with no or minor symptoms
Median time to full-blown AIDS years
Up to 15% live 5 years or longer
Multiple medications
61% of patients discontinue due to side effects

10. AIDS Stress of diagnosis Ongoing stress
Stress management interventions = less anxiety and depression and increased immune fx
Less disease progression 2 year follow-up
Ongoing stress
CBT can buffer increased viral load
Viral load predicts onset of full AIDS

11. Cancer (Psychoncology)
Psychological influences on development and course
Early research prolonged survival with therapy (Spiegel)
2 times as long as controls
at 4 years, 1/3rd tx group alive, no controls
Ease of intervention

12. Cancer How do psychological interventions work? Better health habits
Closer adherence to treatment
Improved endocrine functioning
Better response to stress
Improved immune functioning
Enhanced social adjustment
Better coping

13. Cancer
Psychological preparation for children

14. Cardiovascular Problems - Hypertension
Risk for stroke, heart disease, kidney disease
Symptoms can be invisible
High association with early mortality
Blood vessels constrict, heart works harder (wear and tear)

15. Psychological Influences on Hypertension
personality
Coping style
stress levels
Social support
Loneliness, depression
Hostility
Time urgency

16. Coronary Heart Disease
Stress, anxiety, anger
Poor coping
Low social support
Stress-reduction programs yield 34% reduction in death from heart attack
Type A behavior pattern
2x likely to develop CHD (longitudinally)

17. Coronary Heart Disease and Chronic Negative Emotions
Mixed findings Type A
Measurement
Some components, not others
Anger responsible for much of effect
Impairs pumping efficiency in lab
Associated with artery calcification
Time urgency also important
Anxiety/depression
Depression = 3x likely death after heart attack

18. Chronic Pain Pain as beneficial, motivational
$125 billion annually is spent on chronic pain
80% of doctor’s visits due to pain
Acute pain
Chronic pain

19. Psychological and Social Aspects of Pain
Severity of pain does not predict reaction
What impacts reaction?
Sense of control
Can I deal with the pain and it’s consequences?
Positive control = less distress, disability
Increase concrete coping (e.g., exercise)
Depression, anxiety, social support

20. Biological Aspects of Pain
Gate Control Theory
Nerve impulses from stimuli, to spine, to brain
Dorsal horns of spinal column = gate
If stimuli intense, gate open and pain signal sent
Brain will send signals back to spinal cord, impacting gate
Inhibitory or excitatory messages

21. Biological Aspects of Pain
Endogenous opiods
Shut down pain
In presence of injury or tissue damage
Sense of control can increase endogenous opiods

22. Chronic Fatigue Syndrome
Lack of energy
Marked fatigue
Aches and pains
Low-grade fever
No physical pathology was found
Neurasthenia (“lack of nerve strength”)

23. Symptoms of Chronic Fatigue Syndrome
Medically unexplained fatigue of at least 6 months
Of new onset
Not from exertion
Not alleviated by rest
Reduction in previous activity level
4 or more of:
Subjective memory impairment
Sore throat
Tender lymph nodes
muscle pain
Joint pain
Headache
Unrefreshing sleep
Postexertional malaise

24. Chronic Fatigue Syndrome
Often substantial disability
Unsure of cause
Viruses
Immune system dysfunction
Depression
Toxins
Nonspecific response to stress
CBT seems relatively effective

25. Psychosocial Treatment for Physical Disorders
In animal models, pain can = death
Stress management often component in medical treatment
Biofeedback
Relaxation & Meditation
Comprehensive Stress & Pain Reduction Program
Denial as Coping

26. Biofeedback Patients aware of own bodily functions
Blood pressure
Brain waves
Heart rate
Muscle tension
1960s Miller - rats learn to control responses
Physiological monitoring makes response visible

27. Biofeedback Work with therapist to change response
Success = signal
People can control with good accuracy

28. Relaxation and Meditation
Progressive muscle relaxation
Used in conjuction with other interventions
Meditation
Transcendental meditation (Focus on mantra)
Mindfulness meditation

29. Denial as a Means of Coping
Optimism can speed recovery
Rapid return to normal activities
Better quality of life
Less likely to use denial
Denial
Avoid treatment
Not notice changes

30. Denial as a Means of Coping
Initial denial of seriousness can be helpful
Better endurance shock
Decreased time in ICU

31. Modifying Behaviors to Promote Health
Remember psychological factors influence health in 2 ways:
Direct effect on biological processes
Risky health behavior
Four areas of interest:
Injury Prevention
AIDS Prevention
Smoking
Stanford Community Study

32. Injury Prevention Leading cause of death aged 1-45
High loss of productivity
Prevention in children
Escaping fire
Reporting emergencies
Crossing the street

33. AIDS Prevention Changing behavior only effective prevention
Testing does not necessarily change behavior
Targeting risky behavioral effective
Increase self-efficacy & control

34. Comprehensive Stress- and Pain-Reduction Program
Components of stress management
Monitor stress and identify stressful events
Deep muscle relaxation
Appraisals of events
Importance
Impact
Time management
Assertiveness training
Better than individual components