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Lecture

Psychology 46-355 health psychology

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Department
Psychology
Course
46-355
Professor
Cochran
Semester
Summer

Description
PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY I. Psychological and Social Factors That Influence Health A. Behavioral medicine, or the study, prevention, and treatment of medical and psychosomatic disorders and of undesirable behaviors, such as overeating and substance abuse, by the application of behavior therapy techniques, such as biofeedback, relaxation training, and hypnosis. Health psychology - subfield of behavioral medicine that addresses psychological factors important in the promotion and maintenance of health, including improvements in health care systems and health policy formulation. B. The DSM-IV codes physical disorders on Axis III and recognizes that psychological factors can affect medical conditions. C. Psychological and social factors can affect the basic biological processes that lead to illness and disease (stress). Long-standing behavior patterns may put people at risk to develop certain physical diseases. 1. AIDS is an example of a disease that is influenced by psychological (i.e., stress) and behavioral patterns (i.e., life- style risk behaviors). 2. As many as 50% of all deaths from the 10 leading causes of death in the United States can be traced to life-style behaviors (e.g., smoking-19% of all deaths, poor eating, lack of exercise, insufficient injury control such as not wearing seat belts). 3. At present, some of the major contributing factors to illness and death are psychological and behavioral. The textbook illustrates this fact using an example of the relation between genital herpes and stress. (10-15% of pop has it; larger concentration among young people. Pain, itching, sores. 4/year or more. Behavioral factor, plus stress control reduces number of outbreaks and duration.) D. Stress is the psychological factor that has received the greatest amount of attention in relation to health and disease. Hans Selye's early experimental work with rats led to the area of study known as stress physiology. Selye noted that daily injection of substances in rats was sufficiently stressful to cause ulcers and atrophy of the immune system tissue (chemical vs control). PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 2 Stress is referred to in this chapter as a physiological response of an individual to a stressor. Selye theorized that the body progressed through the following stages in response to sustained stress (general adaptation syndrome). 1. The first phase represents a type of alarm response to immediate threat or danger. 2. With ongoing stress, the body advances to a second stage of resistance where coping mechanisms are mobilized. 3. Finally, if the stress is too intense or lasts too long, the body enters a third stage of exhaustion where permanent damage or death may occur. E. Physiologically, stress activates the sympathetic branch of the autonomic nervous system (i.e., fight or flight), including the HYPAC axis (Hypothalamic-Pituitary-Adrenalcortical Axis). In addition to changes in the flow of neurotransmitters under stress, much attention has focused on the endocrine system's neuromodulators or neuropeptides that act very much like neurotransmitters in carrying the brain’s messages to various parts of the body. 1. Corticotropin releasing factor (CRF) is secreted by the hypothalamus and stimulates the pituitary gland, which in turn, activates the adrenal gland to produce corticosteroids such as the hormone cortisol. Because of their close relation with the stress response, cortisol and other related hormones are known as stress hormones. 2. The HYPAC axis is closely related to the limbic system. The limbic system contains the hippocampus, a structure that is involved in emotional memories and one that is highly responsive to cortisol. When the hippocampus is stimulated during HYPAC activity, it helps to turn off the body’s stress response. The study of this feedback loop is important because changes in these areas can significantly impact one's mental and physical health. For example, work with primates has shown that increased levels of cortisol in response to chronic stress may kill nerve cells in the hippocampus, thereby diminishing the body’s ability to stop the stress response cycle, including memory functioning (impairing problem-solving, leading to more stress). Chronic stress and anxiety can also cause hippocampal cell death in humans (e.g., persons with PTSD). PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 3 A. Psychological and social factors profoundly influence stress physiology. For example, work with baboons indicates that high levels of cortisol correlate with low social status. The most likely explanation is excess secretion of CRF by the hypothalamus in subordinate animals combined with a diminished sensitivity of the pituitary gland. Thus, the body system is less efficient in stopping the stress response. Subordinate baboons also have fewer circulating lymphocytes (white blood cells) -- a sign of immune system suppression -- than dominant males. Also less circulating HDL cholesterol. The primary benefit conferred on the dominant males seems to be predictability and controllability, with stability and controllability together being the most important factors. (During years when there was active competition between dominant males, their hormone profiles were more like those of subordinate males. 1. Stressful life events combined with psychological vulnerabilities are important in psychological and physical disorders and the same holds for the relation between emotional disorders and physical disorders. a. Males who develop psychological disorders such as depression or anxiety, or who were highly stressed, are more likely to develop chronic illness or die at a higher rate than males who are free from psychological disorders. Thus, the same type of stress that contributes to psychological disorders may also contribute to the later development of physical disorders. b. The underlying physiology of stress, anxiety, depression, and excitement may be similar, but psychological factors (e.g., sense of control, self-efficacy) seem to differ and lead to different feelings. (See page 249.) PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 1 B. Physiologically, stress activates the sympathetic branch of the autonomic nervous system (i.e., fight or flight), including the HYPAC axis (Hypothalamic-Pituitary-Adrenalcortical Axis). In addition to changes in the flow of neurotransmitters under stress, much attention has focused on the endocrine system's neuromodulators or neuropeptides that act very much like neurotransmitters in carrying the brain’s messages to various parts of the body. 1. Corticotropin releasing factor (CRF) is secreted by the hypothalamus stimulates the pituitary gland, which activates the adrenal gland to produce corticosteroids such as the hormone cortisol. Because of their close relation with the stress response, cortisol and other related hormones are known as stress hormones. 2. The HYPAC axis is closely related to the limbic system. Limbic system contains the hippocampus, a structure that is involved in emotional memories and one that is highly responsive to cortisol. When the hippocampus is stimulated during HYPAC activity, it helps to turn off the body’s stress response. Work with primates has shown that increased levels of cortisol in response to chronic stress may kill nerve cells in the hippocampus, thereby diminishing the body’s ability to stop the stress response cycle, including memory functioning (impairing problem-solving, leading to more stress). Chronic stress and anxiety can also cause hippocampal cell death in humans (e.g., persons with PTSD). PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 2 C. The immune system and physical disorders 1. The relation between stress (e.g., tests) and increased risk of infection (e.g., respiratory) is established. This relation is mediated by the immune system, whose purpose is to identify and eliminate foreign materials (i.e., antigens) from the body. Stress affects immune system function rapidly. 2. The immune system consists of two main parts (PAGE 251): humoral branch, which operates in the blood and other bodily fluids cellular branch, which protects against viral and parasitic infections. White blood cells (i.e., leukocytes) are the primary agents of the immune system. Types of leukocytes include: a. Macrophages, which are considered the body’s first line of defense. These cells surround identifiable antigens and destroy them. They also signal lymphocytes. b. Lymphocytes consist of two groups: B and T cells. I. B cells operate within the humoral part of the immune system, release molecules that seek out antigens in the blood and other bodily fluids so as to neutralize them, and produce highly specific molecules called immunoglobins that act as antibodies. After the antigens are neutralized, memory B cells are created so that the next time the antigen is encountered, the immune system response will be faster. This process accounts for the success of inoculations. II. T cells operate in the cellular branch of the immune system and do not produce antibodies. One subgroup, killer T cells directly destroy viral infections and cancerous processes, and subsequently produce memory T cells to speed future response to the same antigen. T4 cells (i.e., helper T cells) enhance the immune system response by signaling B cells to produce antibodies and by telling other T cells to destroy the antigen. PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 3 Suppressor T cells suppress the production of antibodies by B cells when they are no longer needed. Too many T4 cells lead the immune system to be over-reactive and contribute to it attacking the body’s normal cells rather than antigens (e.g., autoimmune diseases such as rheumatoid arthritis). Too many suppressor T cells make the body susceptible to invasion by antigens. Human immunodeficiency virus (HIV) directly attacks T helper cells, thereby weakening the immune system and causing AIDS. D. There are many connections between the nervous system and the immune system. Nerve endings exist in immune system tissues such as the thymus, lymph nodes, and bone marrow. Psychoneuroimmunology (PNI) is an area that studies psychological influences on neurological and immune system response. Examples include the previously described connection between the brain (CNS) and HYPAC axis (hormonal) and the immune system. II. Psychosocial Effects on Physical Disorders A. AIDS has become the highest priority in our public health system. 1. The course of AIDS and AIDS-related complex (ARC) (i.e., HIV infection followed by minor health problems such as weight loss, fever, and night sweats) is variable diagnosis is not made until a severe physical illness is present (e.g., pneumocystis pneumonia, cancer, dementia, wasting syndrome). Median time from initial infection to the development of full- blown AIDS is estimated to range from 7.3 to 10 years or more. 2. Investigators have identified a group of people who have been exposed repeatedly to the AIDS virus but have not contracted the disease. The effect is believed to be due, in large part, to the strength of the cellular branch of their immune systems. Efforts to boost the strength of the immune system may help prevent AIDS. PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 4 3. The stress associated with learning that one has HIV or AIDS can be devastating. Stress reduction programs appear to lessen anxiety and depression associated with learning on has HIV, including increases in immune system functioning as measured by T-helper, inducer (CD4), and natural killer (NK) cells, and reductions in antibodies for two herpes viruses that are closely related to HIV. Two-year follow-up showed less disease progress in the stress reduction group. Similar results have been shown for symptomatic HIV and AIDS patients in response to a cognitive-behavioral stress reduction program. Generally, higher levels of stress and low social support are associated with faster progression of HIV and AIDS. B. Cancer is also influenced by psychosocial factors, and acknowledgement of this connection has led to the growing field of psychoncology. Persons with breast cancer who received psychosocial treatment consisting of coping and stress management techniques live twice as long on the average (i.e., about 3 years) as persons who do not receive this form of intervention. It is believed that such interventions work by fostering better health habits, closer adherence to medical treatment, and enhanced social adjustment and coping; all of which improve endocrine functioning in response to stress and thereby enhance immune system functioning. 1. Perceived lack of control, inadequate coping responses, overwhelming stressful life events, use of inappropriate coping responses (i.e., denial) may contribute, in part, to the development of cancer. PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 5 2. Psychological factors are also implicated in addressing nausea, and often conditioned nausea associated, with chemotherapy treatment. Such reactions usually begin by the fourth or fifth treatment and slowly escalate in severity. Between 18% and 50% of patients report development of conditioned nausea, which can lead to a refusal to continue with chemotherapy regimens. Relaxation and graduated exposure to cues that trigger conditioned nausea can diminish or eliminate the response. (Also the taste aversion conditioning, with the strong-flavored ice cream.) 3. Psychological factors are also involved in the treatment and recovery from cancer in children. Stress and anxiety associated with painful cancer treatments can have detrimental effects on the disease process. Psychological interventions with child cancer patients include pain and stress management procedures, breathing exercises, information about the procedures, and rehearsal of the procedures with dolls. C. Cardiovascular problems involve parts of the cardiovascular system, comprised of the heart, blood vessels, and mechanisms for regulating their function. This system is also intricately involved in alarm responses to threat or danger (sympathetic nervous system activity). Problems with the cardiovascular system include stroke (i.e., cerebral vascular accidents)--temporary blockage of blood vessels that cause brain damage and loss of functioning. PHYSIC AL DISORDERS AND HEALTH PSYCHOLOGY - 6 Cardiovascular problems that are receiving the most attention are hypertension and coronary heart disease. (Textbook case - John) 1. Hypertension (i.e., high blood pressure) is a major risk factor for stroke, heart disease, and kidney disease. This risk is derived from constriction of blood vessels, which in turn, causes the heart to work harder to force blood to all parts of the body. The result, in turn, is increased pressure. Hypertension results in wear and tear of the blood vessels, leading to cardiovascular disease. Most cases of hypertension have no verifiable physical cause, and are therefore labeled essential hypertension. a. High blood pressure is in excess of 160/95, with values of 140/90 or above considered borderline, and cause for concern. Systolic blood pressure is represented by the first value and indicates the pressure when the heart is pumping blood. The second value is diastolic blood pressure, and represents the pressure between beats when the heart is at rest. Elevations of diastolic pressure are more worrisome in terms of risk of disease. b. About 20% of all adults between the ages of 25 and 74 suffer from essential hypertension African Americans are twice as likely to develop hypertension as whites. Hypertension also runs in families and the biological vulnerability for hypertension is easy to activate. (People with normal blood pressure, whose parents have high BP, have more reactive blood pressure, even in infancy.) c. Neurobiological causes of hypertension are linked to the autonomic nervous system and mechanisms regulating sodium in the kidneys, both of which are important in regulating blood pressure. PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY - 7 d. Activation of the sympathetic branch of the ANS con
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