Psychophysiological disorders

Lecture 1

In these 2 lectures we will cover..

• definition of psychophysiological disorder

• definition and measurement of “stress”

• physiological explanations of stress response

• personaility factors affecting response to stress

• behavioural and cognitive factors affecting

response to stress

DIATHESIS-STRESS

• constitutional predisposition

triggered by

• environmental stress

PSYCHOPHYSIOLOGICAL disorders

• psychological/emotional factors which predisposeindividuals to develop physical illness

• DSM IV-R

Axis I “psychological factors affecting medicalcondition”

stress...

• Lazarus 1968

“STRESS OCCURS WHEN A SITUATION IS

APPRAISED AS EXCEEDING A PERSON’S

ADAPTIVE RESOURCES”

• ... not the situation/environment per se, but the

way the person interprets the experience

An exam situation...

...stress is produced when

• She perceives the result as an importantdeterminant of her success

• she perceives it as taxing or exceeding her abilityto prepare for and complete it successfully

• perception of the demands in relation to personalresources – and strategies available to deal withthem

Moderators of stress

• Coping strategies (problem focused, emotion

focused)

• Social support (structural, functional - critically

NONEVALUATIVE)

• Social conflict predicts poor outcome in people

with coronary heart disease

• Social isolation confers heightened risk for

coronary heart disease

Measuring stress

• Life Change Units - Combine life event frequencyand intensity/salience

• Life event = something which demands resourcesand requires personal or social adjustment

• divorce or vacation +ve or –ve

• LCU calculated for a particular period of time byadding weighted scores of events experienced

Categories of ‘stressor’

• Life events

• Holmes & Rahe (1967): SCHEDULE OFRECENT EVENTS

• Daily Hassles?

• ... unwanted visitors, parking tickets, no milk inthe fridge.

• Population specific- daily hassles for collegestudents (Kohn et al 1990)

Traumatic stress...

• Higher death rate in

widowers within 6 months

of death of spouse

(relative to age-related

norms)

• Higher incidence of

hospital visits and 19%

increase in death rate

following Mt St Helens

eruption in 1980….

The “weak link in the chain”

• no evidence that different psychological stressors

relate to different physical disorders –

• individual’s constitutional vulnerability

determines the organ/system ‘reactive’ to stress

• stomach.. skin ..lungs ..heart

Explaining psychophysiological

responses to stress

• Stress produces specific adverse physiological

reactions and direct damage to the body

• Stress damages the body indirectly by increasing

unhealthy behaviours

• Stress induces unhealthy cognitions and

behaviours in certain personality types, making

them vulnerable to physical illness

Physiological explanations

• emphasis on causal role of constitutional reactivity

• stem from evolutionary model –

• response to psychological threat mimics evolutionary response

to physical threat - increased b/p, muscle tension, respiratory

changes

• These have become automatic responses to psychological

stress

• often maladaptive – counterproductive – debilitating

Selye (1976)

General Adaptation syndrome

Damage may be caused by different

routes:

• inherited physiological reactivity in Autonomic

Nervous System

• specific organ vulnerability - inherited

• individual biological reactions - inherited/acquired

• immune system changes

physiological reactivity

Fewer

hippocampal

neurons

More

cortisol

secretion

Destruction of hippocampal neurons

Decreased ability to shut of cortisol secretion

Prolonged stress

Immune system changes

Psychoneuroimmunology

Studying evidence for stress-related loweringof body’s resistance to infection/virus

“immunocompetence” = immune systemefficiency

in animals... Sklar & Anisman (1979)

• introduced cancerous growths into 2identical sets of mice

• half exposed to intermittent electric shock

• Cancerous tumours developed more rapidlyin stressed group

in humans...

• reduced efficiency of immune system

(Kiecolt-Glaser & Glaser, 1970s, 80s, 90s)

• colds and stress

• depression

• unemployment

• marital disruption

• bereavement

two possible mechanisms

• Natural killer cell: cytotoxicity significantly

diminished by induced negative self evaluations

(Strauman et al 1993)

• Efficiency of natural DNA repair systems: reduced

by stress (Glaser et al 1985)

coronary heart disease

• Most widely researchedpsychophysiological disorder

• Consider a) unhealthy behaviours and b)personality traits/cognitions in relation toCHD

Coronary heart disease

• ARTERIOSCLEROSIS - thickening and

stiffening of coronary arteries, often a

consequence of chronic hypertension

• ATHEROSCLEROSIS – thickening of coronary

arteries by deposition of cholesterol

• MYOCARDIAL INFARCTION - heart attack

- death of tissue as a result of lack of oxygen

following blockage in coronary artery

physiological risk factors for CHD...

• Growing old

• Being male

• Smoking cigarettes

• Physical inactivity

• Having high serum

cholesterol

• Enlarged left ventricle

• Diabetes

• Having high blood

pressure

high blood pressure

• Approximately 25 million individuals have elevated

blood pressure.

• Consistent or frequent elevation = HYPERTENSION

• 92-98% of those suffering from hypertension show no

discernible organic cause

• ESSENTIAL / PRIMARY HYPERTENSIVES

• For this group, environmental stress plays a

critical role in development of hypertension

• high stress jobs + high basal blood pressure

and/or cardiovascular reactivity = essential

hypertension risk

Personality as a risk factor?

• first suggested by Friedman (1969) and Friedman

and Rosenman (1974)

• described individual with a CORONARY-

PRONE personallity...

a TYPE A individual

“any person who is aggressively involved in a

chronic incessant struggle to achieve more

and more in less and less time”

typical Type A individual...

• ..is competitive and ambitious

• ..has exaggerated sense of time urgency

• ..is aggressive and hostile

• ..is over-committed to work

• (characteristics may emerge as early as 3-4 yrs old)

• Others not displaying these characteristics are

classified by default as Type Bs – relaxed, serene,

no sense of time urgency

Type A/B can be differentiated by

questionnaire or interview..

• Structured interview: affective/expressive styleand behaviour

Rosenthan et al (1964)

• Jenkins Activity Survey: self report

Jenkins (1968)

TRAIT vs REPONSE STYLE

• first considered as a fixed set of traits – maybe more appropriate to think of it asRESPONSE STYLE

• not invariant overt behaviour pattern –situational

• differs between populations - not allenvironments induce it

• High percentage are white middle income,middle class males

• embedded within social context ofcompetitive occupational careers in US andsimilar cultures

• in this setting may be highly adaptiveresponse style leading to desired materialgoals

Situation dependent style –

• Ratings drop radically in 50 somethings

• Bages et al (1997) – 45 University employees

• Asked participants, spouses and work supervisors

to assess Type A behaviour, anger, social support

measures in their respective environments

• Home environment: Participants andspouses agreed on all measures.

• Work environment: Participants and worksupervisors agreed on Type A assessment

• Spouses vs Work supervisors: virtually nooverlap

• situation specific Type A Behaviour Pattern