1. Physical Disorders and Health Psychology Chapter seven

2. Some terms.. Behavioral medicine Applying behavioral sciences to prevention, diagnosis and treatment of medical problems Health psychology Psychological factors in the health and wellness, including health care systems and health care policies

3. Biopsychosocial approach Psychological and social factors lead to illness and disease Long-standing behavior problems may put people at risk to develop diseases DSM codes physical disorders on Axis III: Psychological factors affecting medical condition

4. DSM A. A general medical condition is present (Axis III) B. Psychological factors adversely affect the general medical condition in one of the following ways: 1. influence course of the condition such as close relationship between psychological factors and development, exacerbation or delayed recovery from medical condition 2. factors interfere with tx of med condition

5. DSM… Stress-related responses precipitate or exacerbate medical condition

6. DSM examples Depression delaying recovery from heart attack Anxiety exacerbating asthma Denial of need for surgery Hostility and pressured behavior contributing to heart attack Maladaptive behaviors (overeating,unsafe sex, lack of exercise) Stress related responses

7. Psychosocial factors AIDS Influenced by stress and behavioral patterns 50% of all deaths from 10 leading causes of death in the USA traced to life-style

8. Defining stress A negative emotional experience accompanied by predictable biochemical, physiological, cognitive and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects

9. stressors The events themselves Stressful experiences

10. Person-environment fit Consequence or appraisal: Resources sufficient to meet the demands of the environment?

11. Early theories Fight or flight response Selye: General Adaptation Syndrome Alarm Resistance exhaustion

12. Tend and Befriend Affiliative responses to stress Especially in females, fight or flight may lead to social and nurturant behaviors Oxytocin: stress hormone especially modulated by estrogen

13. Psychological Appraisal and the experience of stress Primary appraisal Is the event positive, neutral or negative in its implications? If negative, to what extent is it presently harmful, threatening for the future, and potentially challenging

14. Secondary Appraisal Are coping abilities and resources sufficient to overcome the harm, threat or challenge posed by the event? Physiological, cognitive, emotional behavioral responses

15. The physiology of stress Sympathetic-adrenomedullary system (SAM) Hypothalamic-pituitary-adrenocortical axis (HPA) Repeated activation leads to cumulative damage

16. Physiology of stress Activates sympathetic nervous system Neurotransmitters and neuromodulators (neuropeptides) CRF : corticotrophin releasing factor Pituitary>adrenal gland>corticosteroids Cortisol: the stress hormone Hippocampus; emotional memory, helps turn off stress response

17. Hippocampus Cortisol impacts Hippocampus and may diminish its ability to turn off stress response Cortisol may influence memory functioning Chronic state or arousal

18. premature aging Allostasis: physiological systems fluctuate to meet demands of stress Over time problems include: Immune system Inability to shut off cortisol Lowered heart rate variability Elevated epinephrine levels Decrease hippocampus volume?

19. What makes events stressful? Events are stressful to the extent that they are perceived as stressful Negative events more stressful than positive events Uncontrollable events more stressful than controllable or predictable events Ambiguous events often perceived as more stressful than clear-cut events

20. What makes events stressful? Overloaded people more stressed than people with fewer tasks to perform

21. Which stressors? Central life domains Investment of self Example : parenting role Example : single mothers

22. Adaptation To mild stressors Severe stress causes chronic problems: Persistent arousal Psychological distress Reduced task performance Gradual reduction in cognitive capabilities

23. Psychoneuroimmunology Behavioral factors CNS Immune system health

24. model Stressful life events impact Immune functioning which modifies Host resistance to immune-related diseases

25. Immune functioning Implications of stress induced immune changes for susceptibility to disease not yet established Small but significant changes in immune functioning People under stress report more URI

26. Upper respiratory illness Major stressful events Chronic family conflict Disruptive daily events Increase risk of URI

27. Latest studies Experimental inoculation of virus (virus challenge studies) Negative mood prior to exposure= greater severity of colds and flu But……. Multiple pathways….

28. Psychosocial factors Changes in health-related behaviors Poor nutrition, smoking, drug and alcohol, lack of exercise, poor sleep Must be other mechanisms working as these factors do not account for all variability

29. Physiological markers Few basic markers that provide poor overall estimate of ability to resist disease

30. Immunocompetence Limited to blood and saliva studies Percentage/absolute numbers of immune cells Immune cells incubated with antigens: resultant proliferation as measure Antibody production in response to inoculation

31. immunocompetence Antibody response generally thought good indicator, however.. Herpes virus: elevated response means weakened immune system

32. Chronic stressors & immune changes Job stress Long-term unemployment Loss of relationship through death Separation/divorce Caring for relative with Alzheimer's Natural disasters May persist with prolong stressor exposure

33. Bereavement May be related more to level of depression Caregivers Higher levels of depression, higher reports of illness and decreased life satisfaction