Health Psychology Health Psychology & Behavioral Medicine & Behavioral Medicine

Health psychology Health psychology Studies the Studies the relationship between psychological relationship between psychological factors and physical healthfactors and physical health

Behavioral Medicine Behavioral Medicine Interdisciplinary Interdisciplinary field integrating behavioral and field integrating behavioral and medical knowledgemedical knowledge

Health Psych Division 38Health Psych Division 38

Health Psychology Health Psychology True or FalseTrue or False

Half the mortality from the 10 leading causes of death is due to Half the mortality from the 10 leading causes of death is due to people’s behavior people’s behavior

People tend to die younger in lower socio-economic settingsPeople tend to die younger in lower socio-economic settings Compared to others, pessimists are more than twice as likely Compared to others, pessimists are more than twice as likely

to develop heart diseaseto develop heart disease Writing about personal traumas in a diary reduces stress and Writing about personal traumas in a diary reduces stress and

the likelihood of stress-related health problemsthe likelihood of stress-related health problems Religious faith and health show a strong positive correlationReligious faith and health show a strong positive correlation Smoking a cigarette takes 11 minutes off one’s life expectancySmoking a cigarette takes 11 minutes off one’s life expectancy Genes influence one’s propensity to cigarette addictionGenes influence one’s propensity to cigarette addiction

Leading Causes of Death 1900 and Leading Causes of Death 1900 and 20002000

Health and StressHealth and Stress

StressStress A state of psychological tension A state of psychological tension or strain where we respond to life or strain where we respond to life events that we events that we appraiseappraise as as threatening or challenging.threatening or challenging. DistressDistress and and EustressEustress

StressorsStressors Events or Events or circumstances that trigger stresscircumstances that trigger stress

AdjustmentAdjustment Any attempt to cope with Any attempt to cope with stressstress

Sources of DistressSources of Distress Everyday Everyday HasslesHassles – Specific examples? – Specific examples?

PressurePressure FrustrationFrustration Discrimination*Discrimination* Conflict*Conflict*

Extreme EventsExtreme Events and Stress and Stress BereavementBereavement and lossand loss UnemploymentUnemployment Divorce and separationDivorce and separation Catastrophes Catastrophes CombatCombat

Sources of StressSources of Stress

Major life changesMajor life changes – – Social Readjustment Rating Scale (SRRS)Social Readjustment Rating Scale (SRRS) [Holmes & Rahe][Holmes & Rahe] Assesses impact of major life changesAssesses impact of major life changes Problems: Adult oriented. Fails to account for different Problems: Adult oriented. Fails to account for different

contexts. Individual and cross-cultural limitationscontexts. Individual and cross-cultural limitations

SRSS online SRSS online H&R Non-Adult Life Event ScaleH&R Non-Adult Life Event Scale

Daily Hassles:Daily Hassles: Approach-Approach-Avoidance Avoidance

Opposing TendenciesOpposing Tendencies (Lewin) Four types of AA conflicts (Lewin) Four types of AA conflicts Approach/Approach conflictApproach/Approach conflict – When a person is – When a person is

simultaneously attracted to two appealing goals. Conflict simultaneously attracted to two appealing goals. Conflict arises from choice, e.g.?arises from choice, e.g.?

Avoidance/AvoidanceAvoidance/Avoidance – When a person is facing two – When a person is facing two undesirable or threatening choices. “A rock and a hard undesirable or threatening choices. “A rock and a hard place” scenario. Examples?place” scenario. Examples?

Approach/AvoidanceApproach/Avoidance – A person is simultaneously – A person is simultaneously attracted to and repelled by the attracted to and repelled by the samesame situation. situation. Mmmm…cheesecake, fatteningMmmm…cheesecake, fattening

Multiple Approach/Avoidance Multiple Approach/Avoidance – Several alternative – Several alternative courses of action with many promising an distressing courses of action with many promising an distressing aspects, e.g. college…aspects, e.g. college…

Extreme Stress: Psychological Extreme Stress: Psychological ConsequencesConsequences

Post-Traumatic Stress Post-Traumatic Stress Disorder (PTSD)Disorder (PTSD) Episodes of anxiety, Episodes of anxiety,

recurrence, sleepless- recurrence, sleepless- ness, and nightmaresness, and nightmares

Victims may withdraw Victims may withdraw from social life, job from social life, job and/or family and/or family responsibilitiesresponsibilities

DepressionDepression and and suicidesuicide

Stress ReactionStress Reaction General Adaptation Syndrome (Hans Seyle)General Adaptation Syndrome (Hans Seyle)

Alarm reactionAlarm reaction ( (sympathetic arousalsympathetic arousal-need to fight off -need to fight off physical or psychological threats – Cannon’s physical or psychological threats – Cannon’s fight or flight). ). EpinephrineEpinephrine

Adaptation/ResistanceAdaptation/Resistance (effort to maintain high level of (effort to maintain high level of resistance-attempts to maintain psychological equilibrium. resistance-attempts to maintain psychological equilibrium. CorticosteroidCorticosteroid production. How we measure… production. How we measure…

ExhaustionExhaustion (depletion of reserves) (depletion of reserves)

The body is designed to cope with temporary stress; prolonged The body is designed to cope with temporary stress; prolonged stress leads to physical deterioration due to destructive levels of stress leads to physical deterioration due to destructive levels of corticosteroids (cortisol)corticosteroids (cortisol)

Parasympathetic rebound can lead to death

Selye’s GASSelye’s GAS

Stressresistance

Phase 1Alarm

reaction(mobilize

resources)

Phase 2Resistance(cope with stressor)

Phase 3Exhaustion(reservesdepleted)

The body’s resistance to stress canlast only so long before exhaustion sets in

Stressoroccurs

Stress and DiseaseStress and Disease

Psycho-physiological illness Psycho-physiological illness Stress-related physical illnessStress-related physical illness Some hypertension, headaches, and gastrointestinal issuesSome hypertension, headaches, and gastrointestinal issues NOT NOT hypochondriasis = misinterpreting physical sensations misinterpreting physical sensations

as symptoms of a diseaseas symptoms of a disease

Psycho-neuroimmunological diseasePsycho-neuroimmunological disease Interaction between Interaction between stress and the immune, endocrine, and nervous systemsstress and the immune, endocrine, and nervous systems Chronic stress can suppress immune function. Role of Chronic stress can suppress immune function. Role of

cortisol cortisol (lymphocytes) Possible link between stress and cancerPossible link between stress and cancer

Stress and the Immune SystemStress and the Immune System

During stress, energy is mobilized away from the immune During stress, energy is mobilized away from the immune system AND stress hormones (corticosteroids) reduce system AND stress hormones (corticosteroids) reduce lymphocyte productionlymphocyte production

The Brain on StressThe Brain on Stress

The damaging (and helpful) effects of stress on the brain and The damaging (and helpful) effects of stress on the brain and cognition (hippocampus & cortisol, emotions and memory, cognition (hippocampus & cortisol, emotions and memory, brain-blood barrier, brain degeneration…Assignment)brain-blood barrier, brain degeneration…Assignment)

The Human Brain – StressThe Human Brain – Stress Resource: The Brain: Teaching ModulesResource: The Brain: Teaching Modules Stress and MemoryStress and Memory

Stress and the Role ofStress and the Role of AppraisalAppraisal““Psychological stress resides neither in the situation nor the Psychological stress resides neither in the situation nor the person; it depends on the transaction between the two. It person; it depends on the transaction between the two. It arises from how a person appraises an event and adapts to it.” arises from how a person appraises an event and adapts to it.” ((LazarusLazarus…Remember him?)…Remember him?)

Stress impact depends on frequency, duration and intensity as Stress impact depends on frequency, duration and intensity as well as personality, coping style and events of the daywell as personality, coping style and events of the day

Locus and Loss of ControlLocus and Loss of Control

Catastrophic events, major life changes, daily hassles and Catastrophic events, major life changes, daily hassles and conflicts are especially stressful when perceived as out of conflicts are especially stressful when perceived as out of one’s control.one’s control.

Changes in workplace and nursing home settings (Rodin) that Changes in workplace and nursing home settings (Rodin) that increase control result in less stress and illness, and reported increase control result in less stress and illness, and reported higher life satisfactionhigher life satisfaction

Discovering Psych - Health Discovering Psych - Health

Pessimism and Heart DiseasePessimism and Heart Disease

Pessimistic adult men are twice as likely to develop heart Pessimistic adult men are twice as likely to develop heart disease over a 10-year period (Kubzansky et al., 2001)disease over a 10-year period (Kubzansky et al., 2001)

Optimistic Explanatory StyleOptimistic Explanatory Style

Those with optimistic (instead of pessimistic) explanatory styles tend to have more control over stressors, cope better with stressful events, have better moods, and have stronger immune systems

Stress and Individual DifferencesStress and Individual Differences

HardinessHardiness A characteristic of people who can tolerate stress A characteristic of people who can tolerate stress well or even thrive on itwell or even thrive on it

ResilienceResilience Ability of a person to “bounce back” after a Ability of a person to “bounce back” after a stressful event (stressful event (Resiliency theoryResiliency theory) Resilience Q) Resilience Q

Self-imposed stress Self-imposed stress People who have irrational, self-defeating People who have irrational, self-defeating beliefs that add unnecessarily to the normal stresses of living beliefs that add unnecessarily to the normal stresses of living

Socioeconomic and Gender Socioeconomic and Gender DifferencesDifferences

Research findingsResearch findings

Lower socioeconomic status can predict more stressful Lower socioeconomic status can predict more stressful environments and fewer psychological resources for dealing environments and fewer psychological resources for dealing with stresswith stress

Women and men seem to be equally affected by stress Women and men seem to be equally affected by stress physiologically, but deal with it differently physiologically, but deal with it differently (tend and befriend) – role of – role of oxytocin). ).

Stress and Health: Type A and B Stress and Health: Type A and B (and D) Personalities(and D) Personalities

Type AType A Competitive, hard-driving (Friedman and Competitive, hard-driving (Friedman and Rosenman). Correlates with heart disease. Primarily due Rosenman). Correlates with heart disease. Primarily due to 1) negative emotions (anger/hostility) and 2) associated to 1) negative emotions (anger/hostility) and 2) associated behaviors (behaviors (impatience, verbal aggressiveness, and anger)impatience, verbal aggressiveness, and anger)

Type B Type B More easygoing, relaxed peopleMore easygoing, relaxed people

Type D Type D Emotionally distressed people. Often characterized Emotionally distressed people. Often characterized by social withdrawal. Correlates with higher rates of by social withdrawal. Correlates with higher rates of stress, disease and deathstress, disease and death

Types of Stress ResponseTypes of Stress Response

Life events

Tendency towardHealth Illness

Personal appraisalChallenge Threat

Personality typeEasy goingNondepressed

Optimistic

HostileDepressedPessimistic

Personality habitsNonsmokingRegular exerciseGood nutrition

SmokingSedentary

Poor nutritionLevel of social support

Close, enduring Lacking

Direct CopingDirect Coping

Direct/Proactive coping Direct/Proactive coping Use of intentional methods to address stress Use of intentional methods to address stress Confrontation/Compromise/WithdrawalAnticipate stressful events and take steps to avoid themAnticipate stressful events and take steps to avoid them

Positive reappraisal (again, Lazarus)Positive reappraisal (again, Lazarus)Alter the way you think about a stressful situation or make Alter the way you think about a stressful situation or make the best of a tense or stressful event. Importance of humorthe best of a tense or stressful event. Importance of humor

V. Defensive CopingV. Defensive Coping

Defensive coping Defensive coping Occurs when one cannot identify Occurs when one cannot identify the source of stress or does the source of stress or does nothing to change the situationnothing to change the situation

Use of Use of self-deceptive techniques self-deceptive techniques known as known as defense mechanisms to to reduce stress. Types include reduce stress. Types include denial, repression, projection, denial, repression, projection, regression, reaction formation, regression, reaction formation, displacement, and sublimationdisplacement, and sublimation

Methods of Reducing StressMethods of Reducing Stress

Calm downCalm down Exercise and healthy lifestyleExercise and healthy lifestyle Relaxation training (Relaxation training (biofeedback)) MeditationMeditation

Reach outReach out Social support network Social support network

Religion Religion Studies have shown an association between religion and Studies have shown an association between religion and

lower stress levelslower stress levels AltruismAltruism

Giving to others (do good…)Giving to others (do good…) Shown to be a good way to reduce stressShown to be a good way to reduce stress

Biofeedback, Relaxation, and Biofeedback, Relaxation, and MeditationMeditation

Biofeedback systems use Biofeedback systems use electronic devices to inform electronic devices to inform people about their physio-people about their physio-logical responses and gives logical responses and gives them the chance to bring them the chance to bring their response to a healthier their response to a healthier range range (Neal Miller). Relaxation Relaxation and meditation have similar and meditation have similar effects in reducing tension effects in reducing tension and anxietyand anxiety

Religiousinvolvement

Healthybehaviors

(less smoking,drinking)

Social support(faith

communities,marriage)

Positiveemotions

(less stress,anxiety)

Better health(less immune systemsuppression, stress

hormones, and suicide)

The Religion FactorThe Religion Factor

Why Do People Smoke?Why Do People Smoke?

Social rewardsSocial rewards Genetic factorsGenetic factors Smoking/Nicotine removes Smoking/Nicotine removes

unpleasant cravings (aka unpleasant cravings (aka negative reinforcementnegative reinforcement) by ) by triggering epinephrine, triggering epinephrine, norepinephrine, dopamine, norepinephrine, dopamine, and endorphinsand endorphins

Nicotine itself is rewarding Nicotine itself is rewarding (positive reinforcement)(positive reinforcement)