Physical Disorders and Health

Psychology

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

Behavioral medicine Prevention, diagnosis, treatment Interdisciplinary

Health psychology Psychological factors important in promotion,

maintenance of health Health care policy

Ways Psychology Influences Health

1. Affect basic biological process that lead to illness

E.g stress and cardiovascular health

2. Influence risky behavior

Smoking Alcohol Nutrition

Selye’s General Adaptation Syndrome

Body’s response to sustained stress

1. Alarm

2. Resistance

3. Exhaustion

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

Psychological Effects on Physical Disorders

1. AIDS

2. Cancer

3. Cardiovascular Problems1. Hypertension

2. Coronary Heart Disease

4. Chronic Pain

5. Chronic Fatigue Syndrome

AIDS

40 million worldwide live with AIDS (2003) 20-40% of pop’n in southern Africa

Course variable Up to years with no or minor symptoms Median time to full-blown AIDS 7.3-10 years Up to 15% live 5 years or longer Multiple medications

61% of patients discontinue due to side effects

AIDS

Stress of diagnosis 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

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

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

Cancer

Psychological preparation for children

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)

Psychological Influences on Hypertension

• personality

•Coping style

• stress levels

•Social support

•Loneliness, depression

•Hostility

•Time urgency

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)

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

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

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

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

Biological Aspects of Pain

Endogenous opiods Shut down pain In presence of injury or tissue damage Sense of control can increase endogenous opiods

Chronic Fatigue Syndrome

Lack of energy Marked fatigue Aches and pains Low-grade fever No physical pathology

was found Neurasthenia (“lack of

nerve strength”)

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

Chronic Fatigue Syndrome

Often substantial disability Unsure of cause

Viruses Immune system dysfunction Depression Toxins Nonspecific response to stress

CBT seems relatively effective

Psychosocial Treatment for Physical Disorders

o In animal models, pain can = deatho Stress management often component in

medical treatment

1. Biofeedback

2. Relaxation & Meditation

3. Comprehensive Stress & Pain Reduction Program

4. Denial as Coping

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

Biofeedback

Work with therapist to change response Success = signal

People can control with good accuracy

Relaxation and Meditation

Progressive muscle relaxation Used in conjuction with other interventions

Meditation Transcendental meditation (Focus on mantra) Mindfulness meditation

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

Denial as a Means of Coping

Initial denial of seriousness can be helpful Better endurance shock Decreased time in ICU

Modifying Behaviors to Promote Health

Remember psychological factors influence health in 2 ways:

1. Direct effect on biological processes2. Risky health behavior

o Four areas of interest:1. Injury Prevention2. AIDS Prevention3. Smoking4. Stanford Community Study

Injury Prevention

Leading cause of death aged 1-45 High loss of productivity Prevention in children

Escaping fire Reporting emergencies Crossing the street

AIDS Prevention

Changing behavior only effective prevention Testing does not necessarily change

behavior Targeting risky behavioral effective Increase self-efficacy & control

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