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Chapter 5

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Psychology 2035A/B
Doug Hazlewood

69 CHAPTER 5 PSYCHOLOGY AND PHYSICAL HEALTH LEARNING OBJECTIVES Stress, Personality, and Illness (APA Goal 4) • Describe the Type A personality and evidence regarding its most toxic element. • Discuss possible explanations for the link between hostility and heart disease. • Summarize evidence relating emotional reactions and depression to heart disease. • Describe the evidence linking stress and personality to cancer. • Summarize evidence linking stress to a variety of diseases and immune functioning. • Evaluate the strength of the relationship between stress and illness. Habits, Lifestyles, and Health (APA Goals 4, 9) • Give some reasons for why people develop health-impairing habits. • Discuss the health effects of smoking and the dynamics of giving up smoking. • Summarize data on patterns of alcohol use and the short-term risks of drinking. • Describe the major long-term health risks and social costs of drinking. • Discuss the health risks and determinants of obesity. • Outline the key elements in effective weight loss efforts. • Provide examples of links between nutrition and health and discuss the basis for poor nutrition. • Summarize evidence on the benefits and risks of exercise. • List four guidelines for embarking on an effective exercise program. • Describe AIDS and summarize evidence on the transmission of the HIV virus. Reactions to Illness (APA Goal 4) • Summarize evidence on patterns of treatment-seeking behavior. • Explain the appeal of the “sick role.” • Identify the factors that tend to undermine doctor-patient communication and how to improve it. • Discuss the prevalence of nonadherence to medical advice and its causes. APPLICATION: Understanding the Effects of Drugs (APA Goal 1) • Explain the concepts of drug tolerance, physical and psychological dependence, and overdose. • Summarize the main effects and risks of narcotics and sedatives. • Summarize the main effects and risks of stimulant drugs and hallucinogens. • Summarize the main effects and risks of marijuana and ecstasy (MDMA). 70 CHAPTER 5 CHAPTER OUTLINE I. Introduction A. The biopsychosocial model holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors 1. A new model for explaining patterns of disease, illness 2. Suggests that biological factors operate in psychosocial context B. Health psychology is concerned with how psychosocial factors relate to the promotion and maintenance of health, and with the causation, prevention, and treatment of illness 1. Growing recognition that psychological factors influence physical health led to the development of this new specialty area 2. Ways psychological factors can influence physical health, including cultural values and reactions of family members II. Stress, Personality, and Illness A. Personality, emotions, and heart disease 1. Coronary heart disease results from a reduction in blood flow through the coronary arteries, which supply the heart with blood a. Atherosclerosis (the gradual narrowing of the coronary arteries) is principal cause b. Can eventually result in heart attack (myocardial infarction) c. Inflammation may contribute to atherosclerosis and elevated coronary risk 2. Hostility and coronary risk a. Type A personality includes three elements: a strong competitive orientation, impatience and time urgency, and anger and hostility 1) Tend to be highly competitive, achievement-oriented workaholics 2) Easily aggravated, get angry quickly 3) Hostility, a persistent negative attitude marked by cynical, mistrusting thoughts, feelings of anger, and overtly aggressive actions, appears to be key component linking Type A personality and coronary risk b. Type B personality is marked by relatively relaxed, patient, easygoing, amicable behavior 1) Less hurried, competitive, than Type As 2) Less easily angered c. A modest correlation exists between Type A behavior and increased coronary risk d. A stronger link exists between hostility, a persistent negative attitude marked by cynical, mistrusting thoughts, feelings of anger, and overtly aggressive actions, and increased coronary risk 1) Anger-prone individuals exhibit greater physiological reactivity 2) Hostile people create additional stress for themselves 3) Hostile individuals have less social support 4) People high in anger and hostility have higher prevalence of poor health habits 3. Emotional reactions and heart disease a. Transient mental stress and the resulting emotions can tax the heart b. Laboratory experiments with cardiology patients have shown that brief periods of mental stress can trigger acute cardiac symptoms 71 c. Stress management training is promising to reduce likelihood of additional heart attacks 4. Depression and heart disease a. Depressive disorders, which are characterized by persistent feelings of sadness and despair, are fairly common b. Studies have found elevated rates of depression among heart patients c. The emotional dysfunction of depression may cause heart disease and influence its progression B. Stress and cancer 1. Cancer: refers to malignant cell growth, which may occur in many organ systems in the body 2. Research linking psychological factors to onset of cancer is weak a. High stress precedes the development of cancer b. Stress is related to but is not necessarily causally linked to cancer 3. Stress, personality factors can influence course of disease a. Onset of cancer frequently sets off a chain reaction of stressful events b. These stressors may contribute to the progress of the disease c. Prospects appear better for those who can maintain emotional stability and enthusiasm C. Stress and other diseases 1. The onset or progress of many health problems may be affected by stress. Some examples: a) Common cold b) Rheumatoid arthritis c) Asthma d) Irritable bowel syndrome e) And many others 2. Many stress-illness connections based on tentative, inconsistent findings D. Stress and immune functioning 1. Immune response: the body's defensive reaction to invasion by bacteria, viral agents, or other foreign substances 2. Stress is related to suppressed immune activity 3. Chronic stress can reduce both cellular immune responses (which attack intracellular pathogens, such as viruses) and humoral immune responses (which attack extracellular pathogens, such as bacteria) 4. The duration of a stressful event is a key factor regarding its impact on immune function 5. In the face of stress, people’s immune systems fight off illness less successfully with increasing age E. Conclusions 1. Virtually all research is correlational a. No cause-and-effect relationship can be established b. Some research designs may have inflated correlation 2. Research consistently indicates relationship between stress and health is modest 3. A complex network of biopsychosocial factors influence health a. Genetic endowment b. Exposure to infectious agents and environmental toxins 72 CHAPTER 5 c. Lifestyle habits d. Use of medical care and cooperation with medical advice III. Habits, Lifestyles, and Health A. Unhealthy behaviors are responsible for about half of all deaths each year 1. Examples include smoking, poor diet/physical inactivity, alcohol consumption, unsafe driving, sexually transmitted diseases, and illicit drug use 2. Health-impairing habits creep up on people slowly 3. Habits may involve activities that are pleasant 4. Risks tend to lie in distant future 5. People tend to underestimate risks associated with own health-impairing habits 6. Some people exhibit unrealistic optimism wherein they are aware that certain health- related behaviors are dangerous, but they erroneously view those dangers as risks for others rather than themselves 7. Inconsistency of messages in media are confusing and undermine motivation to pursue healthy habits B. Smoking 1. Health effects a. Smokers face much greater risk of premature death, with life expectancy reduced by about 13-14 years 1) Overall risk is positively correlated with number of cigarettes smoked, tar and nicotine content 2) Cigar, pipe smoking also associated with elevated health risks, although less hazardous than cigarettes b. Smoking raises risk for various cancers (not limited to lung cancer), cardiovascular disease, and pulmonary disease 2. Giving up smoking a. Health risks decline reasonably quickly when people give up smoking b. Most smokers would like to quit but are reluctant to do so 1) Giving up a source of pleasure 2) Dealing with cravings, weight gain, anxiety and irritability, reduced ability to cope with stress c. Evidence suggests that readiness to quit builds gradually as people cycle through periods of abstinence, relapse d. Most people who quit successfully do so alone, without professional help e. Evidence on effectiveness of nicotine substitutes is moderate C. Drinking 1. Alcohol also a leading cause of health problems 2. About half of adult population in U.S. drink 3. Particularly prevalent on college campuses a. Many students engage in binge drinking b. Students spend far more money on alcohol than on books 4. Why do people drink? a. “Who cares?” brand of euphoria temporarily boosts self-esteem b. Negative emotions, inhibitions are dulled c. Social factors and advertising 5. Short-term risks and problems a. Life-threatening overdoses are more common than most people realize 73 b. Alcohol can have negative effects on intellectual functioning and perceptual- motor coordination, contributing to auto and other types of accidents c. Some drinkers become argumentative and prone to aggression d. Alcohol contributes to student rapes and violence on campus e. Alcohol can contribute to reckless sexual behavior 6. Long-term health effects and social costs a. Alcohol dependence (alcoholism): a chronic, progressive disorder marked by a growing compulsion to drink and impaired control over drinking that eventually interferes with health and social behavior b. Problem drinking associated with wide range of serious health problems (e.g., cirrhosis of liver, coronary disease, hypertension, stroke, certain types of cancer) c. Alcoholism can produce severe psychotic states D. Overeating 1. Obesity: the condition of being overweight as defined in terms of body mass index (BMI), weight in kilograms divided by height in meters, squared (km/m2) a. Common health problem b. Similar to smoking in its subtle association with increased risk of coronary disease, hypertension, stroke, respiratory problems, etc. c. Evolutionary-oriented researchers explain over-eating in terms of misplaced tendency to store food in body for future food shortages 2. Determinants of obesity a. No such thing as "obese personality" b. Chief among the factors contributing to obesity is genetic predisposition c. Excessive eating and inadequate exercise, partly due to technological and cultural changes d. Set point: represents body's natural point of stability in weight 1) Theory suggests that body monitors fat cells to keep them fairly stable 2) Functions to keep body weight within limited range e. Settling-point theory proposes that weight tends to drift around the level at which the constellation of factors that determine food consumption and energy expenditure achieve an equilibrium 1) Weight tends to remain stable as long as there are no durable changes in any of the factors that influence it 2) If an obese person makes long-term changes, the settling point will drift downward without active resistance 3) More encouraging to those who hope to lose weight 3. Losing weight a. Increasing number of people trying to lose weight b. Modest weight reduction can significantly diminish many health risks associated with obesity c. To lose weight, must change ratio of energy intake (from food consumption) to energy output (from physical activities) d. Three options in trying to change ration of energy input to energy output 1) Sharply reduce food consumption 2) Sharply increase exercise output 3) Simultaneously decrease food intake and increase exercise output e. Most experts recommend third option f. Surgery is an increasingly popular choice for weight control g. Self-modification techniques can be helpful in achieving gradual weight loss 74 CHAPTER 5 h Weight-loss programs are moderately successful in the short term, but in the long run the majority of people regain weight E. Poor nutrition 1. Nutrition: a collection of processes (mainly food consumption) through which an organism utilizes the materials (nutrients) required for survival and growth 2. Nutrition and health a. Heavy consumption of foods that elevate serum cholesterol level (e.g., eggs, butter, shellfish) seems to increase risk of heart disease b. Vulnerability to cardiac disease may be influenced by other dietary factors (such as amount of fiber, processed grains, red meats, etc.) c. High salt intake contributing factor in development of hypertension d. High caffeine consumption may increase risk for hypertension e. High-fat diets may contribute to some forms of cancer 3. The basis for poor nutrition a. Poor nutrition is more widespread in U.S. than people realize b. Most people's nutritional shortcomings are result of ignorance, poor motivation 4. Nutritional goals a. Consume balanced variety of foods b. Avoid excessive consumption of fats, cholesterol, refined grain carbohydrates, sugar, and salt c. Increase consumption of complex carbohydrates, polyunsaturated fats, natural sugars, and fiber F. Lack of exercise 1. Benefits and risks of exercise a. Regular exercise associated with greater longevity 1) Enhances cardiovascular fitness 2) Avoidance of obesity-related health problems 3) Linked with reduced risk for certain kinds of cancer a) Colon cancer in men b) Breast, reproductive cancer in women 4) Can serve as buffer to reduce physical effects of stress 5) May have a favorable impact on mental health 6) Exercise can produce desirable personality changes that may promote physical wellness, improvements in mood, self-esteem, work efficiency, and lowered tension and anxiety 2. Devising an exercise program a. Look for an activity that you will find enjoyable b. Increase participation gradually c. Exercise regularly without overdoing it d. Reinforce yourself for participation e. It's never to late to begin an exercise regimen G. Behavior and AIDS 1. Acquired immune deficiency syndrome (AIDS): a disorder in which the immune system is gradually weakened and eventually disabled by the human immunodeficiency virus (HIV) 2. AIDS is final stage of HIV infection process 75 3. Until recently, average length of survival was about 18-24 months, but encouraging advances in treatment with protease inhibitors hold promise for longer survival 4. Highly active antiretroviral therapy holds promise for substantially longer survival 5. Transmission a. Through person-to-person contact involving exchange of bodily fluids, primarily semen, blood b. Two principal modes are sexual contact, sharing of needles by intravenous (IV) drug users c. No evidence that it can be spread through casual contact 6. Misconceptions a. Many people have unrealistic fears that AIDS can be readily transmitted through casual contact, such as a handshake, a sneeze, or an eating utensil b. Many young heterosexuals who are sexually active with a variety of partners downplay their risk for HIV 7. Prevention a. Having sexual contact with fewer partners b. Using condoms to control exchange of semen c. Curtailing certain sexual practices (i.e., anal sex) d. Recognizing implications of risky sexual practices in general IV. Reactions to Illness A. The decision to seek treatment 1. Variations in perception of symptoms help explain individual differences in tendency to seek treatment a. More likely to seek treatment when symptoms are unfamiliar, frightening, or disruptive of work, social activities b. Reaction of friends, family an important factor c. Women more likely than men to use medical services d. Young children and older adults more likely to use health services 2. The process of seeking medical treatment can be divided into three stages of active, complex problem-solving a. Decide that physical symptoms are symptoms b. Decide that apparent illness warrants medical attention c. Make arrangements for medical care, may be complicated, time-consuming B. The sick role 1. Although many people tend to delay medical consultations, some people are actually eager to seek medical care 2. Up to 60% of visits to primary care physicians appear to have little medical basis 3. Some people grow to like sick role because of its potential benefits a. Absolves people from responsibility for their incapacity b. Can be used to exempt them from normal responsibilities c. Attention paid to sick person may be rewarding 4. In contrast, some people refuse to play the sick role under any circumstances C. Communicating with health providers 1. A large portion of medical patients leave their doctors’ offices with lack of understanding 2. Barriers to effective provider-patient communication a. Medical visits are usually quite brief, allowing little time for discussion 76 CHAPTER 5 b. Illness and pain are subjective, difficult to describe c. Many providers use too much medical jargon d. Some providers discourage their patients’ information seeking e. Patients may forget to report some symptoms f. Some patients are evasive because they fear a serious diagnosis g. Many patients are reluctant to challenge doctors’ authority h. Medical professionals often believe their explanations are clear, when patient misunderstanding is common D. Adherence to medical advice 1. Many patients fail to adhere to physicians’ instructions a. Fail to begin treatment regimen b. Stop the regimen early c. Reduce or increase levels of treatment d. Inconsistent or unreliable in following treatment procedures 2. Considerations that influence the likelihood of adherence a. Patients simply forget instructions or fail to understand the instructions as given b. If the prescribed regimen is unpleasant, compliance will tend to decrease c. If a patient has a negative attitude toward a physician, noncompliance increases d. Treatment adherence can be improved when physicians do follow-ups V. Understanding the Effects of Drugs A. Drug-related concepts 1. Tolerance: a progressive decrease in a person's responsiveness to a drug with continued use 2. Physical dependence: when a person must continue to take a drug to avoid withdrawal illness (which occurs when drug use is terminated) 3. Psychological dependence: when a person must continue to take a drug to satisfy intense mental and emotional craving for the drug a. Not marked by clear withdrawal reaction b. Can create powerful, overwhelming need for drug 4. Overdose: an excessive dose of a drug that can seriously threaten one's life a. Any drug can be fatal if person takes enough of it b. Some drugs have greater potential for overdose than others 1) CNS depressants (narcotics, sedatives) carry greatest risk of overdose 2) Many overdoses involve combinations of CNS depressants B. Narcotics 1. Narcotics (or opiates) are drugs derived from opium and are capable of relieving pain; this term is used legally to refer to haphazard variety of drugs besides opiates 2. Effects of heroin a. Main effect is overwhelming sense of euphoria b. Side effects include nausea, lethargy, drowsiness, constipation, etc. 3. Risks a. High risk for both physical, psychological dependence b. Users tend to develop drug-centered lifestyle c. Overdose is real danger d. Potential for contraction of infectious diseases through sharing of needles C. Sedatives 77 1. Sedatives: sleep-inducing drugs that tend to decrease central nervous system activation and behavioral activity (e.g., barbiturates, Valium) 2. Effects a. Euphoria similar to drinking large amounts of alcohol b. Relaxed state of intoxication c. Side effects include diminished motor coordination, sluggish intellectual functioning, instability in emotions 3. Risks a. Can produce physical, psychological dependence b. Among leading causes of overdoses c. Elevated risk of accidental injury D. Stimulants 1. Stimulants: drugs that tend to increase central nervous system activation and behavioral activity (e.g., cocaine, amphetamines, caffeine, nicotine) a. "Crack" is freebased from cocaine b. Amphetamines are synthesized in laboratory ("crank" or "crystal meth") 2. Effects a. Produce energetic, enthusiastic euphoria b. Side effects include increased blood pressure, muscle tension, restlessness 3. Risks a. Physical dependence is relatively mild, psychological dependence is exceptionally powerful b. Can suppress appetite, disrupt sleep; leads to deterioration in physical health c. Heavy use can lead to amphetamine or cocaine psychosis, with extreme paranoia d. Overdoses on cocaine have increased sharply in recent years E. Hallucinogens 1. Hallucinogens are a diverse group of drugs that have powerful effects on mental and emotional functioning, marked most prominently by distortions in sensory and perceptual experience (e.g., LSD, mescaline, psilocybin) 2. Effects a. Intensify and distort perception b. Temporarily impair intellectual functioning c. Feelings of euphoria d. Nightmarish feelings of anxiety, fear, and paranoia, commonly called a “bad trip.” 3. Risks a. No potential for physical dependence, psychological dependence appears to be rare b. No deaths attributed to overdose c. In seve
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