Physical Disorders
and Health
Psychology
Psychological and Social
Influences on Health
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Contribute to top fatal diseases
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50% of deaths from 10 leading causes of
death in US can be linked to behavior
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Behavioral medicine
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Prevention, diagnosis, treatment
Interdisciplinary
Health psychology
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Psychological factors important in promotion,
maintenance of health
Health care policy
Ways Psychology Influences
Health
1.

Affect basic biological
process that lead to
illness
E.g stress and
cardiovascular health
2.
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Influence risky
behavior
Smoking
Alcohol
Nutrition
Selye’s General Adaptation
Syndrome
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1.
2.
3.
Body’s response to sustained stress
Alarm
Resistance
Exhaustion
Stress and the Immune System
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Early research on
stress and cold viruses
Psychological impact
on immune functioning
Depression has a direct
effect?
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Self care and risky
behaviors
Psychological Effects on
Physical Disorders
AIDS
Cancer
Cardiovascular Problems
1.
2.
3.
1.
2.
4.
5.
Hypertension
Coronary Heart Disease
Chronic Pain
Chronic Fatigue Syndrome
AIDS
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40 million worldwide live with AIDS (2003)
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20-40% of pop’n in southern Africa
Course variable
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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
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61% of patients discontinue due to side effects
AIDS
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Stress of diagnosis
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Stress management interventions = less anxiety
and depression and increased immune fx
Less disease progression 2 year follow-up
Ongoing stress
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CBT can buffer increased viral load
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Viral load predicts onset of full AIDS
Cancer (Psychoncology)
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Psychological influences on development and
course
Early research prolonged survival with
therapy (Spiegel)
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2 times as long as controls
at 4 years, 1/3rd tx group alive, no controls
Ease of intervention
Cancer
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How do psychological interventions work?
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Better health habits
Closer adherence to treatment
Improved endocrine functioning
Better response to stress
Improved immune functioning
Enhanced social adjustment
Better coping
Cancer
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Psychological
preparation for children
Cardiovascular Problems Hypertension
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Risk for stroke, heart disease, kidney disease
Symptoms can be invisible
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High association with early mortality
Blood vessels constrict, heart works harder
(wear and tear)
Psychological Influences on
Hypertension
• personality
•Coping style
• stress levels
•Social support
•Loneliness,
depression
•Hostility
•Time urgency
Coronary Heart Disease
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Stress, anxiety, anger
Poor coping
Low social support
Stress-reduction programs yield 34%
reduction in death from heart attack
Type A behavior pattern
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2x likely to develop CHD (longitudinally)
Coronary Heart Disease and
Chronic Negative Emotions
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Mixed findings Type A
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Anger responsible for much of effect
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Measurement
Some components, not others
Impairs pumping efficiency in lab
Associated with artery calcification
Time urgency also important
Anxiety/depression
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Depression = 3x likely death after heart attack
Chronic Pain
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Pain as beneficial,
motivational
$125 billion annually is
spent on chronic pain
80% of doctor’s visits
due to pain
Acute pain
Chronic pain
Psychological and Social
Aspects of Pain
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Severity of pain does not predict reaction
What impacts reaction?
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Sense of control
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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
Biological Aspects of Pain
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Gate Control Theory
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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
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Inhibitory or excitatory messages
Biological Aspects of Pain
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Endogenous opiods
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Shut down pain
In presence of injury or tissue damage
Sense of control can increase endogenous opiods
Chronic Fatigue Syndrome
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Lack of energy
Marked fatigue
Aches and pains
Low-grade fever
No physical pathology
was found
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Neurasthenia (“lack of
nerve strength”)
Symptoms of Chronic Fatigue
Syndrome
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Medically unexplained
fatigue of at least 6
months
Of new onset
Not from exertion
Not alleviated by rest
Reduction in previous
activity level
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4 or more of:
Subjective memory
impairment
Sore throat
Tender lymph nodes
muscle pain
Joint pain
Headache
Unrefreshing sleep
Postexertional malaise
Chronic Fatigue Syndrome
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Often substantial disability
Unsure of cause
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Viruses
Immune system dysfunction
Depression
Toxins
Nonspecific response to stress
CBT seems relatively effective
Psychosocial Treatment for
Physical Disorders
o
o
1.
2.
3.
4.
In animal models, pain can = death
Stress management often component in
medical treatment
Biofeedback
Relaxation & Meditation
Comprehensive Stress & Pain Reduction
Program
Denial as Coping
Biofeedback
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Patients aware of own bodily functions
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Blood pressure
Brain waves
Heart rate
Muscle tension
1960s Miller - rats learn to control responses
Physiological monitoring makes response
visible
Biofeedback
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Work with therapist to change response
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Success = signal
People can control with good accuracy
Relaxation and Meditation
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Progressive muscle relaxation
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Used in conjuction with other interventions
Meditation
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Transcendental meditation (Focus on mantra)
Mindfulness meditation
Denial as a Means of Coping
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Optimism can speed recovery
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Rapid return to normal activities
Better quality of life
Less likely to use denial
Denial
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Avoid treatment
Not notice changes
Denial as a Means of Coping
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Initial denial of seriousness can be helpful
Better endurance shock
Decreased time in ICU
Modifying Behaviors to
Promote Health
Remember psychological factors influence
health in 2 ways:

1.
2.
o
1.
2.
3.
4.
Direct effect on biological processes
Risky health behavior
Four areas of interest:
Injury Prevention
AIDS Prevention
Smoking
Stanford Community Study
Injury Prevention
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Leading cause of death aged 1-45
High loss of productivity
Prevention in children
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Escaping fire
Reporting emergencies
Crossing the street
AIDS Prevention
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Changing behavior only effective prevention
Testing does not necessarily change behavior
Targeting risky behavioral effective
Increase self-efficacy & control
Comprehensive Stress- and
Pain-Reduction Program
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Components of stress management
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Monitor stress and identify stressful events
Deep muscle relaxation
Appraisals of events
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Importance
Impact
Time management
Assertiveness training
Better than individual components