1. Psychophysiological Disorders and
Chapter 8
Psychophysiological Disorders and
Health Psychology
Ch 8

2. Psychophysiological Disorders
Psychophysiological Disorders involve genuine physical disorders
Physical symptoms can be caused by or worsened by emotional distress
The category recognizes that a broad range of diseases involving the circulatory, respiratory, digestive and central nervous systems can be influenced by stress
Ch 8.1

3. The Mind-Body Connection: Sobering Facts
Leading Causes of Death (1993)
Cardiovascular Diseases
Cancer
Pulmonary Disease
Accidents
Disorders of Lifestyle / Behavior

4. That Influence Biology
Psychosocial Factors
That Influence Biology
Historical Developments
Apply Behavioral Science to the Prevention, Diagnosis, and Treatment of Medical Problems
Interdisciplinary
Psychosomatic Medicine
Behavioral Medicine

5. That Influence Biology
Psychosocial Factors
That Influence Biology
Study Psychological Factors Important for the Promotion and Maintenance of Heath
Not Interdisciplinary
Historical Developments
Psychosomatic Medicine
Behavioral Medicine
Health Psychology

6. That Influence Biology
Psychosocial Factors
That Influence Biology
Two Kinds of Influence
Factors That:
Lead to Illness and Disease
Increase Risk of Developing Disease
Influence Etiology & Maintenance

7. How Do Psychological and Social Factors Influence Medical Illness?
Figure 9.2
Psychosocial factors directly affect physical health

8. Definitions of Stress Stress is: Stressors are stimuli
An environmental condition that may trigger psychopathology
A response to environmental conditions that leads to emotional upset, deteriorating performance or physiological changes
Stressors are stimuli
Cognitive view of stress places emphasis on the interpretation of external stimuli
Coping refers to how people deal with stress
Ch 8.2

9. The General Adaptation Syndrome
Ch 8.3

10. Measuring Stress: Social Readjustment Rating Scale
The Social Readjustment Rating Scale (SRRS)
Rates the stressfulness of various life events.
Initial scale development
Research participants asked to rate various life experiences for stress impact (marriage = 500)
Final version of scale rank orders life events and assigns proportional score to each event.
Total score on the scale is correlated with diseases such as heart attack and leukemia
Ch 8.4

11. Measuring Stress: Assessment of Daily Experience Scale
Experience (ADE,
Stone & Neale, 1982)
Respondents record
and rate their life experiences
during each day
Research shows that adverse
life events increase prior to an
illness

12. Daily Stress & Illness Figure 8.3
Number of desirable events for the ten days preceding an episode of respiratory infection. After Stone, Reed, & Neale, 1987
Figure 8.4
Number of undesirable events in the ten
days preceding an episode of respiratory
infection. After Stone, Reed, and Neale, 1987

13. That Influence Biology:
Psychosocial Factors
That Influence Biology:
What Influences the Stress Response?
STRESS
A Sense of Control
Coping Skills
Self-Efficacy
Health and Wellness Behaviors
Social Support
Immune System Functioning

14. Social Support and Stress
Karmarck et al. (1995) studied effect of social support on BP in a laboratory
experiment.
Stress led to increases in both diastolic and systolic blood pressure but BP
increases were greatest when the research participant was alone.
The stress had less of an impact on BP when participant was accompanied
by a friend.

15. Biological Theories of the Stress-Illness Link
Somatic-Weakness theory holds that a weak organ system may be susceptible to disruption by stress
Specific-Reaction theory suggests that people respond to stress in unique ways, some organ systems show greater reactivity than do other systems
Allostatic load (McEwen & Seeman, 1999)
When stressors are acute or occur repeatedly, the biological responses to stress (e.g., cortisol secretion) can an have aversive impact on body.
Over time, stress response itself may overwhelm the system
Ch 8.5

16. Stress and the Immune System

17. Psychological Theories of the Stress-Illness Link
Psychoanalytic view holds that specific conflicts give rise to psychophysiological disorders
Cognitive-Behavioral view proposes that humans have higher cognitive functions which can amplify and extend the duration of arousal of our bodies
Ch 8.6

18. Hypertension Hypertension is high blood pressure (bp)
Hypertension leads to heart attacks and strokes
Systolic bp is arterial pressure during contraction of the ventricles of the heart
Diastolic bp is arterial pressure during relaxation of the ventricles of the heart
Increased bp is brought on by increased cardiac output (more blood leaving the heart) or by vasoconstriction of the arteries
Ch 8.7

19. Stress and BP
Stressful conditions produce a short-term increase in blood pressure
These increases return to baseline when the stressor is withdrawn
Studies of blood pressure done on ambulatory subjects reveal that anger is most strongly linked to elevated bp
The changes were large in a subset of subjects
Reactivity refers to increased bp and heart rate in response to stress
Ch 8.8

20. Coronary Heart Disease
Coronary Heart Disease refers to
Angina pectoris: periodic chest pains
Reduced oxygen supply to heart
Myocardial infarction: heart attack
Brought on by a cutoff of oxygen to the heart muscle
Risk factors for MI include age, gender (males), elevated blood pressure, elevated cholesterol, obesity, physical inactivity, excessive use of alcohol and diabetes
Ch 8.9

21. Diatheses for Coronary Heart Disease
Psychological diatheses for CHD include:
Type A behavior pattern (time urgency, competitive, aggressive/hostile)
High levels of anger
Cynicism
Type D personality: high levels of anger, anxiety and depression as well as low levels of emotional expression
Biological diatheses: focus is on reactivity
Ch 8.10

22. Asthma
Characteristics: air passages suddenly narrow, breathing becomes hard (wheezy)
Triggered by allergens, pollution, viruses, cold, and emotional states
Dominant Etiologic Factor (Rees, 1964)
Allergic (23%)
Infective (38%) (but 86% had had infection)
Psychological (37%)

23. AIDS AIDS Is a fatal disease caused viral infection
Compromises the immune system
May arise from irrational and self-defeating behavior
Is treatable, but not presently curable or preventable by medical means
Is preventable by psychological means
Ch 8.11

24. Gender & Health Mortality rates Why differential mortality rates?
Higher for men at every age
Men more likely to die
In auto accidents or by homicide
Of cirrhosis, heart & lung disease, lung cancer, & suicide
Why differential mortality rates?
Hormones may confer protection against life threatening diseases.
Men more likely to be Type A which may increase risk of heart disease.
However, recent research indicates that women may be as prone to anger as men.
Lifestyle differences such as increased consumption of alcohol.
Lifestyle differences may be narrowing
Women drink more alcohol and smoke more than in the past.
Morbidity rates
Higher for women
Women more likely to
Have specific diseases such as diabetes, rheumatoid arthritis, etc.
Visit physicians and use prescription drugs
Why differential morbidity rates?
Women live longer and therefore may be more likely to develop diseases associated with aging.
Women more likely to visit physicians, therefore increasing the likelihood that the diseases they experience are reported to health tracking agencies.
Women experience more stress than men, and rate stress as having a greater impact.
MD’s may treat women’s health concerns less seriously than men’s health concerns
Lower levels of women’s income seem to play a role as does ethnicity.
Research studies on health and stress should include women and men in equal numbers

25. Socioeconomic Status, Ethnicity, & Health
Low SES is associated with higher rates of mortality from all causes
Disease and mortality rates differ by race and ethnicity (perhaps due to association with low SES)
What factors may account for this relationship?
Environmental factors
Increased stressors
Limited access to health services
Unable to afford medical insurance & health care
Biological/genetic differences in incidence of illness may be mediated by behavioral variables (e.g., diet and lifestyle)

26. Therapies for Psychophysiological Disorders
Drug interventions can be used to reduce the physical symptoms brought on by stress
Reduction of anxiety, depression or anger is a key element in the treatment of stress-related disorders
Psychoanalysis: uses free association
Cognitive/behavioral: uses systematic desensitization, in vivo exposure, assertion training
Ch 8.12

27. Treating Hypertension
Non-pharmacological treatments include:
Losing weight
Reducing salt intake
Giving up smoking
Limiting alcohol intake
Getting regular exercise
Relaxation training
Reducing anger
Ch 8.13

28. Physical Disorders Influenced by Psychosocial Factors
Psychosocial Link to Disease
AIDS
Cardiovascular Diseases
Cancer
Chronic Pain
Chronic Fatigue Syndrome
Treatment and Outcome

29. Psychosocial Factors and Cancer The Field of Psychological Oncology
Stress Reduction Prolongs Life
Psychological Factors Influence
Course and Development
Response to Aversive Medical Treatment
Improve Quality of Life
Slow Disease Progression
Psychological Factors are Not Cures!

30. Physical Disorders Influenced by Psychosocial Factors
Psychosocial Link to Disease
AIDS
Cardiovascular Diseases
Cancer
Chronic Pain
Chronic Fatigue Syndrome
Treatment and Outcome

31. Psychosocial Factors and Chronic Pain The Nature of Chronic Pain
$100 Billion Spent on Main Medication in U.S.
Worldwide, 20 Million Tons of Aspirin
Two Kinds of Clinical Pain
Acute Pain
Chronic Pain

32. Psychosocial Factors and Chronic Pain
Psychological and Social Dimensions
Pain Severity Does not Predict One’s Reaction
Differences Are Psychological

33. Psychosocial Factors and Chronic Pain Biological Dimensions
Gate Control Theory
Endogenous Opiods (“Endorphins”)
Phantom Limb Pain

34. Physical Disorders Influenced by Psychosocial Factors
Psychosocial Link to Disease
AIDS
Cardiovascular Diseases
Cancer
Chronic Pain
Chronic Fatigue Syndrome
Treatment

35. in Chronic Fatigue Syndrome
Psychosocial Factors
in Chronic Fatigue Syndrome
The Nature of Chronic Fatigue
Unexplained Fatigue
Variety of Physical Symptoms
Most Common in Women
Often Debilitating

36. Physical Disorders Influenced by Psychosocial Factors
Psychosocial Link to Disease
AIDS
Cardiovascular Diseases
Cancer
Chronic Pain
Chronic Fatigue Syndrome
Treatment and Outcome

37. Psychosocial Treatment for Physical Problems
Available Treatments
Biofeedback
Relaxation Procedures
Hypnosis
Comprehensive Stress Management
Obstacles to Treatment
Denial and Noncompliance
Prevention Efforts

38. Stress Management
Stress Management is a set of techniques used to cope with stress
Arousal can be reduced through relaxation training or by biofeedback
Cognitive restructuring can be used to alter the thought patterns of a person and to increase their perceived level of control
Behavioral skills training relating to time management and how to prioritize
Train the person in how to alter their environment
Ch 8.14

39. Pain Management Pain can be modified by Distraction
Refocusing attention
Lowering anxiety
Effecting a sense of control over pain
Re-labeling the sensation as tickling or numbness
Use of biofeedback
Sensitive instruments that give information about psychophysiological states (e.g., skin temp., muscle tension, EEGs) to increase voluntary control
Ch 8.15