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Chapter 14

Chapter 14 Health Psychology

8 Pages

Course Code
Psychology 2030A/B
David Vollick

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Chapter 14 - Health Psychology Health Psychology: Defining the Field • Health psychology = uses the principles and methods of psychology to understand how attitudes and behaviors influence health and illness • Health psychologists study how people develop (+) and ( -) health habits, how stress and health are related, and which psychological variables affect the onset and treatment of medical illnesses • Health (WHO definition) = state of mental, social, and physical well -being, not just the absence of illness • At the heart of health psychology is the biops ychosocial model which suggests that complex interactions among biological, psychological, and social factors determine health The Mind-Body Relationship • Mind-body dualism (Rene Decartes) o The mind and body function independently although they may interact o This philosophy has persisted for many years; efforts have been to identifying the biological variables behind disease and neglected attention to psychological variables • Mind-body dualism was first challenged by Freud (hysteria, or conversion disorder, li nked the body and the mind) • New ideas also came about implicating psychological conflicts to physical illness involving the autonomic nervous system • Now: Psychologists offer services around prevention, treatment, or management of physical health problems o Psychological variables, such as health habits, attitudes, and personality and social factors such as stress and social supports, are now accepted as major contributors to physical health Psychological Influences on Health • It is now widely accepted that psychological variables and social factors affect physical health • Similarly, medical illness can affect psychological health and social functioning • When medical illness and psychological problems coexist, functioning is even more impaired The Role of Stress in Physical and Mental Health Defining Stress • Stress = any negative emotional experience that is accompanied by biochemical, physiological, cognitive, and behavioral responses that attempt to change or adjust to the stressor • Stressor = any event that produces tension or another negative emotion such as fear and that prepares the person for a fight or flight response o Can be physical (medical disease, physical injury), environmental (natural disaster, high level of noise, change in living situation), int erpersonal-social (breakup, arguments), or psychological • Stress is more likely when the event is perceived as uncontrollable, unpredictable, or ambiguous (leaving the person uncertain what action to take) or when it has an impact on a major area of life • After a stressful event, an interactive appraisal process occurs in which the person assesses whether he/she has the resources or coping skills to deal with the event o Primary appraisal -- the person assess the potential harm or threat; perceptions of threa t are heavily influenced by many psychological and social variables (person’s beliefs and values) o Secondary appraisal -- person identifies available skills to cope with or overcome the possible negative outcomes • Coping strategies: o Problem-focused coping (involves taking action to manage a problem that is creating stress; involves gather information, comparing alternative courses of action, making decisions, etc) o Emotion-focused coping (person focuses on managing emotional distress that results from a stressor rather than trying to change the situation that creates distress) • Problem-focused coping is generally regarded to be more effective for managing stress • Forms of stress: o Acute stress (occurs when a potentially threatening event and the associated reac tion last a brief amount of time) o Chronic stress (develops when a threatening event continues over time; chronic illness, excessive work demands, long term poverty, etc) • The perceived, or actual inability to cope with stressors results in a stress reaction with symptoms of a flight or fight response (increased BP, HR) Measuring Stress • Acute Stress Paradigm (Acute Stress) o Short term stress has characteristics physiological (increased HR, increased BP), neuroendocrine, and psychological responses • Social Readjustment Rating Scale (Impact of life events) o Lists 43 potentially stressful life events, each with a numerical rating that estimates how much life “readjustment” is related to the event o This is a simple way to evaluate the relationship between life events and health o Does not consider individual differences • Hassles Scale (Day-to-day stressors) o Measures the frequency and severity of day -to-day stressors • Uplifts Scale (Day-to-day uplifts) o Measures the day -to-day events that counteract the negative effects of stress The Impact of Stress on Health • Stress can impact health both directly and indirectly o When people feel stressed, they often stop taking care of themselves and develop poor health habits (eat unhealthy food, get less sleep, exercise less) o Injuries are more frequent among people who are under stress o Direct -- stress causes changes in the nervous and endocrine systems and affects the immune system Physiology of Stress • Stress ▯ increases SNS activity ▯ increased blood pressure, more rapid heart and breathing rates, increased blood sugar levels, sweaty palms, muscle tension • Cannon proposed that continual or chronic stress responses could impair a person’s ability to fight illness • Slye (1950) -- General Adaptation Syndrome ; consists of a three-stage process of stress adaptation o Alarm (body mobilized to meet a threat; see increases in SNS activity) o Resistance (the individual attempts to cope with or resist the threat o Exhaustion (when continued efforts to overcome the threat deplete physical resources ) ▯ At this stage, people become more vulnerable to illness • Chronic stress ▯ hypertension, CB disease, diabetes, arthritis • When stress does occur, the stress responses affect two major systems: o Sympathetic-adrenomedullary system (SAM) ▯ Increased adrenal gland stimulation results in the secretion of epinephrine and norephineprhine ▯ Continuous and long -term activation can suppress immune functioning and produce changes in resting BP, HR, etc. o Hypothalamic-Pituitary-Adrenocortical (HPA) axis ▯ During stress, the hypo thalamus increases production of CRF, which causes increased secretion of ACTH and increased cortisol ▯ Increased cortisol helps your body deal with stress (stores carbohydrates, reduces inflammation, returns body to pre-stress state) ▯ Repeated HPA stimulation can change daily cortisol patterns, compromising immune functioning and impairing memory and concentration • Stress and the immune system o Specific immune system = these responses protect us against specific infections and diseases; these responses can be the result of natural or artificial processes o Non-specific immune system = responses offer general protection against infections and diseases (anatomical barriers, phagocytosis, immune cells [T -lymphocytes, killer cells, helper cells, natural killer cells], inflammation) o Psychoneuroimmunology ▯ Study of the relations among social, psychological, and physical responses ▯ People who are under severe stress are more likely to catch a cold, develop an infection, or get the flu ▯ Stress suppresses the ability of the immune system to function properly; wounds heal more slowly, chronic diseases progress more rapidly, vaccinations are less effective. WHY? • Stress increases epinephrine and cortisol levels, and this decreases the activity of the helper T cells and lymphocytes that are important for killing bacteria and other toxins • People under stress also develop fewer antibodies following immunization for flu, hepatitis, and tetanus ▯ Hostility, loneliness, etc. can also result in poorer immune functioning Psychological impact of stress • Stress, poor immune function ▯ increases in negative moods including depression, anxiety, hostility, anger ▯ further reduction in immune function ▯ increased risk of infections • Several psychological disorders are associated with physical str ess responses o Depression, alcoholism, and eating disorders are linked to increased HPA activity o PTSD sufferers have lower NK cell activity and lower T -cell counts and more physical health problems Moderators of Stress • Stress moderators = variables that a ffect how stress is experiences and how it affects health and other aspects of functioning • Characteristic patterns of behavior, thinking, and feeling can increase or decrease the effect of stress on health o Type A behavior pattern (consistently striving fo r achievement, impatience, time urgency, aggressiveness toward othets) has been linked to increased risk of coronary heart disease o Negative affectivity (tendency to experience negative moods including anxiety, depression, and hostility), pessimism (tenden cy to blame negative outcomes on some characteristic of oneself), and optimism (tendency to expect positive outcomes) strongly affect how stress influences health ▯ Negative affectivity & pessimism ▯ poorer immune functioning, poorer response to surgery, more increased physical complaints, poorer long term physical health • External modulators (resources, social support) also influence the impact of stress on health o People with higher SES have better immune function, have fewer medical and psychological problems, and live longer lives o Those with more social support are less distressed, have reduced risks of illness or death, and adjust better to chronic conditions o Support: tangible, informational, emotional Sex, Race, and Developmental Issues • Children vs adults o Children are more likely to have physical complaints such as headaches and stomachaches o Recurrent abdominal pain is the most common complaint during childhood; a physical cause is only identified in 10-15% of cases; stressful event are assumed to be associated with pain episodes • Men vs. woman o Men have greater cortisol and immune system stress responses o Men are more likely to use problem -focused coping; women are more likely to use emotion - focused coping ▯ Women “tend and befriend” • Racial, ethnic differences o Low SES is associated with higher levels of stress and disease • Religion o Studies have shown that people who attend regular church services have improved ability to cope with stress, reduce depression, decrease engagement in adolescent sexual behavi or, and improve cognitive functioning in older adults o Higher levels of religion and spirituality are also associated with reduced BP and hypertension, lowered cortisol responses following stress, and less rapid progression of cancer o Most of this research is correlation! Inconsistencies are found, few variables are standardized, and some define religion and spirituality differently Psychology and Behavior in Medical Illness Behavior and Health • Health behaviors (health habits) are established early in life when people are not yet worried about their health • Data clearly link health behaviors and health status (illness) • Important components of healthy behavior o Healthy eating ▯ <33% of people eat the daily recommended servings of fruit and veggies ▯ People make food choices on both innate and learned taste preferences, foods that are commonly available, and according to their attitudes, knowledge, and beliefs ▯ Stress, anxiety, depression ▯ poorer food choices o Exercise and physical activity ▯ Increased physical activity ▯ decreased resting heart rate, lower blood pressure, improved sleep, lower rates of obesity and CV disease, increased longevity ▯ Regular exercise ▯ improved mood and well-being, lower levels of depression, reduced risk of cognitive impairment, reduced perception of pain ▯ People report that stress and lack of time are the primary reasons or giving up on exercise; however people who exercise cope better with stress o Smoking ▯ Major modifiable risk factor for poor health ▯ Smoking ▯ high rates of lung cancer, CV disease, emphysema, other respiratory problems, death ▯ Most people begin smoking before 18 years old o Sleeping ▯ 30% of people report sleep disruption ▯ Difficulty sleeping can be an acute or chronic condition ▯ Among children, sleepwalking, sleep terrors, nightmares are common • When these behaviors are recurrent, the child may have non -REM sleep arousal disorders o
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