NO CLASS ON THURSDAY FEB. 13

1. Counterproductive copinga. Isolationb. Negative beliefs

2. Social Support: a. Hazards of positive supportb. Hazards of no support

3. Negative stereotypes

4. Medical complications and risks

5. Double binds (1-4, above)

Psycho-social Complications of Chronic Pain

Wrong model:

Pain Depression --- What’s missing?

Correct model:

Pain ↓ activity ↓ mastery ↓ control Depression

Pain and Depression

Pain Prone Personality

Are some personalities more prone to experiencing, reporting pain?

MMPI = Minnesota Multiphasic Personality Inventory

a. Acute pain pats: Hypochondriasis – overly attend to body Hysteria – extreme emotionality/exaggerate symps.

b. Chronic pain pats: Neurotic triad: Hypcondriasis + hysteria + depression

Secondary gain: What are social benefits of pain? Attention, special identity“Functional type”: neurotic triad + schizo / psychopathology / paranoia

Danger of “Pain Prone Personality” concept?

1. Negative stereotypes 2. Causal direction

Drugs

Surgery

Sensory Control: Counter-irritation

“MECHANICAL” PAIN REDUCTION TECHNIQUES

BiofeedbackRelaxationHypnosisAcupunctureGuided ImageryCognitive ReframingDistractionPain Management Programs

“PSYCHOSOCIAL” PAIN REDUCTION TECHNIQUES

Pain Relief Through Virtual RealitySevere burns one of most painful conditions to treat: cleaning, re-bandaging excruciating.

Pennebaker symptom research suggests that distraction should do what to pain?

Reduce it. Why? Competition of cues.

SnowWorld: Virtual Reality program designed for pain relief.

Patients enter SnowWorld during procedures

Shoot snowballs at snowmen, penguins

Report pain reductions 30%-50%

Note SnowWorld colors. Why?

Summary Benefits of Psychosocial Approaches

Change meaning of experience

Provides skill set, reduces helplessness

Gives patients an active role in pain management

Success with techniques increases self-efficacy

Changes ways of thinking

1. Evaluationa. pain b. functional status: life style changes, limitationsc. Emotional and mental functioning

2. Treatment plana. Pre-set time. Not indefinite.b. Specific goals.c. Contract

3. Programa. Education

1. Nature of pain: physio, psychological2. Pain reduction techniques

b. Therapy1. Psycho therapy2. Cognitive therapy:

c. Family therapyd. Relapse prevention

Pain Management Programs

Class 7: Stress I

Stress: Health Psych

“Bullseye”

Integrates mental states, bodily states, environmental conditions

Window to core psych processes:

* How we make sense of events, and how interpretations affect health.

• Emotions, emotions & thinking, emotional control• Social relations in coping and in failed coping

Stress is where psych can do most for health.Causes of illness, Treatment of illness, illness prevention

What Are Stressful Events?

Broken Heart Syndrome

Temporary heart condition due to loss-related stressChest pain, due to surge of stress hormones.

Loss-related stress? Break-upDeathDeparture

“Stress cardiomyopathy”

Duration: typically 1 week

Stress is 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. Taylor, p 168.

Stress Defined

Cannon Model of StressWalter Cannon, 1932

Fight or Flight response

SNS + endocrine mobilizes body for fight or flight

Stressful events

_____You can fight: .....

_____You can flee ...

_____You can neither fight nor flee, "traps"

Which are the most stressful?

X

General Adaptation Syndrome (GAS)

Hans Selye (1956)All stressors produce same pattern:

Enlarged adrenals

Shrunken thymus

Shrunken lymph

Ulcerated stomach

Per Selye: Prolonged stress -->

cardiovascular disease

arthritis

hypertension

compromised immune system

1. SAM: Sympathetic-adrenomedullary

Event cortex hypothalamus SNS adrenal medulla catecholamines charged feeling increased BP, HR, etc.

SAM Corresponds to Cannon's stress model

2. HPA: Hypothlamic-pituitary-adreocortical

Event cortex hypothalamus coritcotrophin releasing factor (CRF) pituitary adrencorticotropic hormone (ACTH) adrenal cortex

corticosteriods conserves carbos reduces inflammation

HPA corresponds to Selye's stress model

Physiology of Stress

SAM and HPTA Stress Patterns

Health Implications of Sustained StressCatecholamine elevation, sustained, inhibits immune system

Cardiovascular effects

1. Arteriosclerosis

2. Senility: neurons in hippocampus

3. Depression

4. Fat distribution: Higher waist-to-hip ratio

5. Sudden death syndrome

Stress, Opioids, and Illness Susceptibility

Opiates are? Pain-reducing drugs, from plants. Morphine, heroin

Endogenous opiods (aka endorphines): Like opiate, produced by body.

Stress triggers endorphine production

Stress opioid release immune suppression ? ↑ illness susceptibility

Prolonged Stress Widens “Window of Vulnerability”

Chronic stress ↑ recovery phase ↑ cortisol phase

↑ immune suppression ↑ illness risk.

Allostatic load = effects of cumulative stress exposure

Reactivity and Stress Vulnerability

People vary in stress reactions

NOT just a matter of being mentally tough / whimpy

Physical constitutions differ

Autonomic NSNeuroendocrine response Immune response

Study of children 3-5 yrs old, reactivityMeasure reactivity to stressor -- a. cardio (HR, BP) b. immuneParents track stressor reactions, illness for 12 weeks Result: stress leads to illness among

____ Low Reactive ____ High Reactive

X

Stress as Function of Person-Environment Fit

Low Stress: Resources >> ChallengeModerate Stress: Resources ≥ ChallengeHigh Stress: Resources < Challenge