Physical Disorders and Health Psychology

Chapter seven

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

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

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

DSM…

• Stress-related responses precipitate or exacerbate medical condition

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

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

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

stressors

• The events themselves• Stressful experiences

Person-environment fit

• Consequence or appraisal:• Resources sufficient to meet the

demands of the environment?

Early theories

• Fight or flight response• Selye: General Adaptation Syndrome

• Alarm• Resistance• exhaustion

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

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

Secondary Appraisal

• Are coping abilities and resources sufficient to overcome the harm, threat or challenge posed by the event?

• Physiological, cognitive, emotional behavioral responses

The physiology of stress

• Sympathetic-adrenomedullary system (SAM)

• Hypothalamic-pituitary-adrenocortical axis (HPA)

• Repeated activation leads to cumulative damage

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

Hippocampus

• Cortisol impacts Hippocampus and may diminish its ability to turn off stress response

• Cortisol may influence memory functioning

• Chronic state or arousal

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?

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

What makes events stressful?

• Overloaded people more stressed than people with fewer tasks to perform

Which stressors?

• Central life domains• Investment of self• Example : parenting role• Example : single mothers

Adaptation

• To mild stressors• Severe stress causes chronic

problems:• Persistent arousal• Psychological distress• Reduced task performance• Gradual reduction in cognitive

capabilities

Psychoneuroimmunology

• Behavioral factors• CNS• Immune system• health

model

• Stressful life events impact• Immune functioning which modifies• Host resistance to immune-related

diseases

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

Upper respiratory illness

• Major stressful events• Chronic family conflict• Disruptive daily events• Increase risk of URI

Latest studies

• Experimental inoculation of virus (virus challenge studies)

• Negative mood prior to exposure= greater severity of colds and flu

• But…….• Multiple pathways….

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

Physiological markers

• Few basic markers that provide poor overall estimate of ability to resist disease

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

immunocompetence

• Antibody response generally thought good indicator , however..

• Herpes virus: elevated response means weakened immune system

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

Chronic stressors & immune changes

• Bereavement• May be related more to level of

depression

• Caregivers• Higher levels of depression, higher

reports of illness and decreased life satisfaction