physical disorders and health psychology. psychological and social influences on health contribute...
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Physical Disorders and Health
Psychology
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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
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Behavioral medicine Prevention, diagnosis, treatment Interdisciplinary
Health psychology Psychological factors important in promotion,
maintenance of health Health care policy
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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
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Selye’s General Adaptation Syndrome
Body’s response to sustained stress
1. Alarm
2. Resistance
3. Exhaustion
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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
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Psychological Effects on Physical Disorders
1. AIDS
2. Cancer
3. Cardiovascular Problems1. Hypertension
2. Coronary Heart Disease
4. Chronic Pain
5. Chronic Fatigue Syndrome
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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
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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
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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
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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
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Cancer
Psychological preparation for children
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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)
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Psychological Influences on Hypertension
• personality
•Coping style
• stress levels
•Social support
•Loneliness, depression
•Hostility
•Time urgency
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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)
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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
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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
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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
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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
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Biological Aspects of Pain
Endogenous opiods Shut down pain In presence of injury or tissue damage Sense of control can increase endogenous opiods
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Chronic Fatigue Syndrome
Lack of energy Marked fatigue Aches and pains Low-grade fever No physical pathology
was found Neurasthenia (“lack of
nerve strength”)
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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
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Chronic Fatigue Syndrome
Often substantial disability Unsure of cause
Viruses Immune system dysfunction Depression Toxins Nonspecific response to stress
CBT seems relatively effective
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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
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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
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Biofeedback
Work with therapist to change response Success = signal
People can control with good accuracy
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Relaxation and Meditation
Progressive muscle relaxation Used in conjuction with other interventions
Meditation Transcendental meditation (Focus on mantra) Mindfulness meditation
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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
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Denial as a Means of Coping
Initial denial of seriousness can be helpful Better endurance shock Decreased time in ICU
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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
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Injury Prevention
Leading cause of death aged 1-45 High loss of productivity Prevention in children
Escaping fire Reporting emergencies Crossing the street
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AIDS Prevention
Changing behavior only effective prevention Testing does not necessarily change
behavior Targeting risky behavioral effective Increase self-efficacy & control
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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