Chapter 5
Psychology and Physical Health
Stress, Personality, and Illness, continued
•
•
Health psychology is “concerned with how
psychological factors relate to the promotion
and maintenance of health, and with the
causation, prevention, and treatment of
illness”.
The biopsychosocial model “holds that
illness is caused by a complex interaction of
biological, psychological, and sociocultural
factors”.
Stress, Personality, and Illness, continued
• Personality, emotions, and heart disease
– Coronary heart disease – “results from a
reduction in blood flow through the coronary
arteries, which supply the heart with blood”.
– Atherosclerosis – “is a gradual narrowing of
the coronary arteries” (see Figure 5.3).
Figure 5.3 Atherosclerosis. Atherosclerosis, a narrowing of the coronary arteries, is the principal cause of
coronary disease. (a) A normal artery. (b) Fatty deposits, cholesterol, and cellular debris on the walls of the
artery have narrowed the path for blood flow. (c) Advanced atherosclerosis. In this situation, a blood clot
might suddenly block the flow of blood through the artery.
Stress, Personality, and Illness, continued
• Hostility and coronary risk
– Research suggests a link between coronary
risk and a behavior pattern termed the Type
A personality.
– Type A personality has three
components:
1. A competitive orientation.
2. Impatience and a sense of time urgency.
3. Anger and hostility.
Stress, Personality, and Illness, continued
Hostility and coronary risk, continued
– The “anger – hostility” component of Type A
behavior has the strongest link to coronary
disease.
•
Research shows that individuals with
above-average hostility scores were twice
as likely to have atherosclerosis than
were those with below-average hostility
scores (see Figure 5.5).
Figure 5.5. Anger and coronary risk. Working with a large sample of healthy men and women who were followed for a
median of 4.5 years, Williams et al. (2000) found an association between trait anger and the likelihood of a coronary event.
Among subjects who manifested normal blood pressure at the beginning of the study, a moderate anger level was associated
with a 36% increase in coronary attacks, and a high level of anger nearly tripled participants’ risk for coronary disease. (Based
on data in William et al., 2000)
Stress, Personality, and Illness, continued
• Emotional reactions and heart disease
– Stress, and its resulting strong emotions,
seems to tax the heart.
– Even brief periods of stress can trigger acute
cardiac symptoms such as angina (chest
pain).
– When interviewed after surviving a heart
attack, many patients say that an episode of
anger triggered the symptoms.
Stress, Personality, and Illness, continued
• Depression and heart disease
– Recent studies suggest that the emotional
dysfunction of depression may cause heart
disease (Goldston & Baillie, 2008).
– Overall, it seems that depression doubles
one’s chances of developing heart disease.
– Depression also seems to affect how heart
disease progresses and is associated with
worse outcomes in cardiology patients.
Stress, Personality, and Illness, continued
• Stress and cancer
– Cancer – refers “to malignant cell growth,
which may occur in many organ systems in
the body”.
– There is no direct evidence that stress
causes the onset of cancer.
•
However, stress and personality can affect
the course of the disease.
Stress, Personality, and Illness, continued
Stress and cancer, continued
– There may be a cancer-prone personality
(Type C).
•
These individuals
– Are passive.
– Do not complain.
– Do not cope well with stress.
– Hold in negative emotions, such as
anger.
Stress, Personality, and Illness, continued
• Stress and other diseases
– Life stress has been associated with the
following:
•
•
•
•
•
Rheumatoid arthritis.
Emergence of lower back pain.
Asthma.
Periodontal disease.
Gastrointestinal disorders.
Stress, Personality, and Illness, continued
• Stress and immune function
– The immune response is “the body’s
defensive reaction to invasion by bacteria,
viral agents, or other foreign substances”.
– A large body of experimental research
indicates that stress can impair immune
functioning in animals.
– Similar immune suppression may also occur
in humans.
Habits, Lifestyle and Health, continued
•
•
As shown in Figure 5.9, unhealthy habits
account for the most premature deaths.
Other leading behavioral causes of death
include
– Alcohol consumption.
– Unsafe driving.
– Risky sexual behavior.
– Illicit drug use.
Figure 5.9. Mortality due to health-impairing behaviors. Synthesizing data from many sources,
Mokdad and colleagues (2004) estimated the number of annual deaths in the United States attributable to
various health-impairing behaviors in an interesting article published in The Journal of the American Medical
Association. As you can see, smoking and obesity are the leading causes of preventable mortality.
However, their mortality estimate for obesity has proven controversial and is the subject of some debate
(some experts argue that their estimate is too high). (Data from Mokdad et al., 2004)
Habits, Lifestyle, and Health, continued
• Smoking
– Health effects associated with smoking
include
•
Greater risk of premature death (13-14
years shorter life expectancy).
•
Lung cancer, as well as higher risk for
many other cancers in the body.
•
Hypertension, stroke, and other cardiac
diseases (see Figure 5.11).
Figure 5.11. Health risks associated with smoking. This figure provides an overview of the various
diseases that are more common among smokers than nonsmokers. As you can see, tobacco elevates
one’s vulnerability to a remarkably diverse array of diseases, including the three leading causes of death in
the modern world – heart attack, cancer, and stroke.
Habits, Lifestyle, and Health, continued
Smoking, continued
– Giving up smoking
•
If people give up smoking, studies show
that their health risks decline reasonably
quickly, reaching normal levels after about
15 years (see Figure 5.12).
•
Quitting smoking is difficult, however, and
many people fail several times before
succeeding.
Figure 5.12. Quitting smoking and mortality. Research suggests that various types of health risks
associated with smoking decline gradually after people give up tobacco. The data shown here, from the
1990 U.S. Surgeon General’s report on smoking, illustrate the overall effects on mortality rates. The
mortality rates on the vertical axis show how much death rates are elevated among smokers and exsmokers in comparison to nonsmokers. For example, a mortality rate of 3.0 would mean that smokers’
death rate was triple that of nonsmokers. (Data from U.S. Department of Health and Human Services,
1990)
Habits, Lifestyle, and Health, continued
• Drinking
– Why do people drink?
•
Drinking is widely endorsed in our culture
and is viewed as a desirable social ritual.
•
Drinking dulls negative emotions such as
tension, worry, anxiety and depression.
•
Alcohol makes people feel more relaxed in
social settings.
•
To keep friends and company.
Habits, Lifestyle, and Health, continued
Drinking, continued
– Short-term risks and problems
• The “hangover”, which includes headache,
dizziness, nausea and vomiting.
• Life-threatening overdoses. This is
especially problematic when alcohol is
mixed with a sedative or narcotic drugs.
• Poor judgment, reduced intellectual
functioning.
• Poor motor coordination.
• Increased anger.
Habits, Lifestyle, and Health, continued
Drinking, continued
– Long-term risks and social costs
•
Alcohol dependence, or alcoholism, is
“a chronic, progressive disorder marked by
a growing compulsion to drink and
impaired control over drinking that will
eventually interfere with health and social
behavior”.
•
See Figure 5.16 for a list of serious health
problems associated with alcoholism.
Figure 5.16. Health risks associated with drinking. This graphic provides an overview of the various
diseases that are more common among drinkers than abstainers. As you can see, alcohol elevates one’s
vulnerability to a remarkably diverse array of diseases.
Habits, Lifestyle, and Health, continued
•
Overeating
– Obesity is a serious risk factor for a number
of health problems and diseases (see Figure
5.17).
Figure 5.17. Weight and the prevalence of various diseases. This graph shows how obesity, as
indexed by BMI, is related to the prevalence of four common types of illness. The prevalence of diabetes,
heart disease, muscle pain, and hypertension all increase as BMI goes up. Clearly, obesity is a significant
health risk. (Data from Brownell & Wadden, 2000)
Habits, Lifestyle, and Health, continued
•
Overeating, continued
– Determinants of obesity: What causes it?
• Genetic factors (heredity) account for the
majority of cases.
• However, environmental factors also
contribute:
– Excessive eating.
– Lack of exercise.
– Overabundance of high-calorie food.
Habits, Lifestyle, and Health, continued
Determinants of obesity, continued
• Set point theory “proposes that the body
monitors fat-cell levels to keep them (and
weight) fairly stable”.
• When fat stores get low, we have
increased hunger and decreased
metabolism, making it difficult to lose
weight.
• Settling point is an alternative theory that
makes more room for long-term benefits of
lifestyle changes.
Habits, Lifestyle, and Health, continued
Overeating, continued
• Losing weight
– Losing even small amounts of excessive
weight can significantly reduce many of the
health risks associated with obesity.
– Essentially, there are three options:
1. Sharply decrease food intake.
2. Sharply increase exercise.
3. Moderate changes in both diet and
exercise (most recommended option).
Habits, Lifestyle, and Health, continued
• Poor nutrition
– Nutrition – “is a collection of processes
(mainly food consumption) through which an
organism utilizes the materials (nutrients)
required for survival and growth.
Habits, Lifestyle, and Health, continued
Poor nutrition, continued
– Nutrition and health
• Numerous studies demonstrate a link
between patterns of nutrition and health.
1. Heavy consumption of foods that raise
serum cholesterol levels (see Figure
5.18).
2. Too little fiber and high intake of red
meats.
Figure 5.18. The link between cholesterol and coronary risk. In a review of several major studies,
Stamler et al. (2000) summarize crucial evidence on the association between cholesterol levels and the
prevalence of cardiovascular disease. This graph is based on a sample of over 11,000 men who were 18 to
39 at the beginning of the study (1967-1973) when their serum cholesterol level was measured. The data
shown here depict participants’ relative risk for coronary heart disease during the ensuing 25 years as a
function of their initial cholesterol level. (Data from Stamler et al., 2000)
Habits, Lifestyle, and Health, continued
Nutrition and health, continued
3. High salt intake is associated with
hypertension.
4. High caffeine consumption is also
associated with hypertension.
5. High-fat diets
– Associated with cardiovascular
disease.
– May contribute to certain types of
cancer.
Habits, Lifestyle, and Health, continued
Nutrition and health, continued
– The basis for poor nutrition
• Most nutrition problems are due to
– Ignorance (we don’t know what’s really
good for us).
– Poor motivation (it takes effort to
change your diet).
• The first steps toward better nutrition are a
change in attitude and access to good
information.
Habits, Lifestyle, and Health, continued
Nutrition and health, continued
– Nutritional goals
1. Consume a balanced variety of foods.
2. Avoid excessive consumption of saturated
fats, cholesterol, refined-grain
carbohydrates, sugar, and salt.
3. Increase consumption of polyunsaturated
fats, whole-grain carbohydrates, natural
sugars, and foods with fiber.
Habits, Lifestyle, and Health, continued
• Lack of exercise
– Benefits of exercise
1. Enhanced cardiovascular fitness.
2. Avoidance of obesity.
3. Decreased risk of colon cancer, and
breast and reproductive cancer in women.
4. Protection from stress.
5. Positive effect on mental health.
6. Increase in desirable personality traits.
Habits, Lifestyle, and Health, continued
Lack of exercise, continued
•
Devising an exercise program
1. Choose an activity you enjoy.
2. Exercise regularly without “overdoing” it.
3. Increase your participation gradually.
4. Reinforce yourself for exercising.
5. It’s never too late to begin!
Habits, Lifestyle, and Health, continued
• Behavior and AIDS
– AIDS (acquired immune deficiency
syndrome), “a disorder in which the immune
system is gradually weakened and disabled
by the human immunodeficiency virus (HIV)”.
Habits, Lifestyle, and Health, continued
Behavior and AIDS, continued
– Transmission
•
HIV is transmitted through contact with
bodily fluids (usually blood or semen) and
certain behaviors increase risk of
contracting HIV:
– Not wearing a condom.
– Sharing needles.
– Anal sex.
Habits, Lifestyle, and Health, continued
Behavior and AIDS, continued
– Misconceptions
•
HIV can be transmitted through casual
contact or by donating blood.
•
You can have risky sex, with many
partners and avoid contracting HIV as long
as you do not use IV drugs or have sex
with bisexual or gay men.
•
You can tell if someone is infected by
looking at them.
Habits, Lifestyle, and Health, continued
Behavior and AIDS, continued
– Prevention
•
•
Have fewer sexual partners.
•
Recognize that, despite advances in
treatment, HIV is still a life-threatening,
serious disease.
Wear latex condoms and limit sex acts that
allow semen and blood to mix (e.g., anal
sex).
Reactions to Illness
•
LEARNING OBJECTIVES
– 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.
Reactions to Illness, continued
•
The decision to seek treatment
– People are most likely to seek treatment for
an illness if
• The symptoms are unfamiliar.
• The symptoms appear to be serious, last
longer than expected, or disrupt work and
social activities.
• Family and friends view symptoms as
serious and encourage them to get
treatment.
Reactions to Illness, continued
Seeking treatment, continued
– The process of seeking treatment has three
stages:
1. We must decide that our physical
sensations are symptoms of illness.
2. We must decide that our symptoms
warrant medical care.
3. We have to arrange for medical care
(make an appointment, prepare to pay,
etc.).
Reactions to Illness, continued
Seeking treatment, continued
•
•
The biggest obstacle to receiving treatment is
procrastination on the part of the patient.
People procrastinate because they
– Downplay significance of the symptoms.
– Don’t want to look foolish if “it’s nothing”.
– Worry about “bothering” their doctor.
– Are reluctant to disrupt their plans.
– Waste time on trivial matters before going to
a hospital emergency room.
Reactions to Illness, continued
•
The sick role
– Some people almost seem to enjoy being
sick. They have learned that the “sick role” is
associated with benefits:
• It absolves people from responsibility.
• Fewer demands are placed on sick
people.
• Illness can provide a “face-saving” excuse
for failure.
• Sick people receive more attention.
Reactions to Illness, continued
•
Communicating with health providers
– Good communication with your provider is
crucial for good medical care.
– Barriers to effective communication:
• Medical visits are very brief.
• Illness and pain are subjective matters
that can be difficult to describe.
• Doctors use too much medical jargon –
they overestimate the patient’s
comprehension of what is being said.
Reactions to Illness, continued
Barriers to communication, continued
•
Some providers discourage patients from
seeking information.
•
Patients may be too upset or ill to
remember what symptoms to report or
which questions to ask.
•
Patients may withhold information for fear
of a more serious diagnosis.
•
In general, patients are too passive.
Reactions to Illness, continued
•
Adherence to medical advice
– Many patients fail to adhere to their
physician’s advice (30-50% of the time), and
this behavior takes many forms:
• Patients fail to begin a treatment regimen.
• Patients stop the treatment early.
• Patients reduce or increase levels of
treatment that were prescribed.
• Patients are inconsistent in following
treatment procedures.
Reactions to Illness, continued
Adherence to medical advice, continued:
– Factors that affect adherence:
•
Complexity of the doctor’s orders –
patients may not understand or may
forget.
•
•
•
How aversive or difficult the treatment is.
Negative attitudes toward a physician.
Whether or not follow-up occurs. This
enhances adherence.
Application: Understanding the Effects of Drugs
•
LEARNING OBJECTIVES
– Explain the concepts of drug tolerance,
physical and psychological dependence, and
overdose.
– Summarize the main effects and risks of
narcotics and sedatives.
– Describe the main effects and risks of
stimulant drugs and hallucinogens.
– Outline the main effects and risks of
marijuana and ecstasy (MDMA).
Application: The Effects of Drugs, continued
•
Drug-related concepts
– “Recreational” drugs usually fall into one of
five common categories (see Figure 5.24).
– Most drugs produce tolerance effects, or a
“decreased responsiveness to a drug with
continued use”.
– Users may also develop a physical and/or
psychological dependence on a drug (see
Figure 5.25).
Figure 5.24. Major categories of abused drugs. This chart summarizes the methods of ingestion, chief
medical uses, and principal effects of five major types of recreational drugs. Alcohol is covered in the main
body of the chapter. (Based on Julien, 2008; Levinthal, 2008; Lowinson, et al., 2005)
Figure 5.25. Specific risks for various categories of drugs. This chart shows estimates of the risk
potential for tolerance, dependence, and overdose for the five major categories of drugs discussed in this
Application.
The Effects of Drugs, continued
Drug-related concepts, continued
– Physical dependence “exists when a person
must continue to take a drug to avoid
withdrawal illness (which occurs when the
drug use is terminated)”.
•
Most severe with heroin and barbiturates.
– Psychological dependence “exists when a
person must continue to take a drug to satisfy
intense mental and emotional craving for it.”
– An overdose is “an excessive dose of a drug
that can seriously threaten one’s life”.
The Effects of Drugs, continued
•
Narcotics
– Narcotics (or opiates), “drugs derived from
opium that are capable of relieving pain”.
– Effects
•
The main effect of the drug is an intense
state of euphoria or sense of well-being
•
Side effects include nausea, drowsiness,
constipation, and slowed respiration.
The Effects of Drugs, continued
Narcotics, continued
– Risks
•
High risk of physical and psychological
dependence.
•
Withdrawal from narcotics is so unpleasant
that addicts often adopt a drug-centered
lifestyle that revolves around obtaining
heroin.
•
•
High risk for overdose.
Contracting diseases if you share needles.
The Effects of Drugs, continued
•
Sedatives
– Sedatives “sleep-inducing drugs that tend to
decrease central nervous system and
behavioral activity” (e.g., Valium).
– Effects
•
Mild euphoria, pleasant relaxed state of
intoxication (similar to effects of alcohol).
•
Side effects include slurred speech and
impaired judgment.
The Effects of Drugs, continued
Sedatives, continued
– Risks
•
Potential for physical and psychological
dependence.
•
High risk for lethal overdose (especially
when combined with alcohol).
•
Elevated risk for accidental injuries due to
impaired motor coordination.
The Effects of Drugs, continued
• Stimulants
– Stimulants – “drugs that tend to increase
central nervous system and behavioral
activity” (e.g., “speed”).
– Effects
• “High energy” euphoria, or enthusiastic,
optimistic, energetic state.
• Side effects include increased blood
pressure, muscle tension, sweating, and
restlessness.
• Some users also experience irritability,
anxiety, and paranoia.
The Effects of Drugs, continued
Stimulants, continued
– Risks
•
Stimulants can cause physical
dependence, but the potential for a
powerful psychological dependence is
much greater.
•
•
•
•
Appetite suppression.
Sleep disruption.
Increased risk for stroke and heart attack.
High risk for overdose with cocaine.
The Effects of Drugs, continued
•
Hallucinogens
– 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”.
– Effects
•
•
•
Distorted perception, intellectual function.
Euphoria, intense experience of emotions.
Side effects can include intense negative
emotional states causing great fear.
The Effects of Drugs, continued
Hallucinogens, continued
– Risks
•
•
Acute panic.
•
Flashbacks, or “vivid hallucinogenic
experiences occurring months after initial
drug ingestion”.
•
However, there is no potential for physical
dependence, and psychological
dependence is rare.
Accidental injuries, or even unintended
suicide, due to disorientation.
The Effects of Drugs, continued
•
Marijuana
– Marijuana is “the hemp plant from which
marijuana, hashish, and THC are derived”.
– Effects
•
•
Mild, relaxed state of euphoria.
•
Side effects include a slight impairment in
mental functioning and decreased
perceptual-motor coordination.
Subtle, and highly individualized, effects
on cognition, emotion, and perception.
The Effects of Drugs, continued
Marijuana, continued
– Risks
•
•
Potential for psychological dependence.
•
•
•
Impaired ability to drive.
Transient anxiety and depression in some
people.
Increased risk for lung disease.
Impairments in attention and memory in
heavy users that can be reversed if the
drug use is terminated (see Figure 5.26).
Figure 5.26. Chronic cannabis use and
cognitive performance. Solowij and
associates (2002) administered a battery of
neuropsychological tests to 51 long-term
cannabis users, who had smoked marijuana
regularly for an average of 24 years; 51
short-term cannabis users, who had
smoked marijuana regularly for an average
of 10 years; and 33 control subjects who
had little or no history of cannabis use. The
cannabis users were required to abstain
from smoking marijuana for a minimum of
12 hours prior to their testing. The study
found evidence suggestive of subtle
cognitive impairments among the long-term
cannabis users on many of the tests. The
graph shown here depicts the results
observed for overall performance on the
Rey Auditory Verbal Learning Test, which
measures several aspects of memory
functioning.
The Effects of Drugs, continued
• Ecstasy (MDMA)
– Ecstasy (MDMA) is a synthetic compound
related to amphetamines and hallucinogens.
– Effects
•
Euphoria; a “warm, friendly” feeling toward
others.
•
•
•
Feelings of sensuality, insight, and empathy.
Increased energy.
Side effects include increased blood
pressure, muscle tension, sweating, blurred
vision, insomnia, and transient anxiety.
The Effects of Drugs, continued
Ecstasy (MDMA), continued
– Risks
•
Potential for psychological dependence in
some users.
•
Heavy use associated with sleep
disorders, depression, increased anxiety,
and hostility.
•
Possibility of long-term effects on cognitive
functioning.
•
Contamination with harmful impurities in
the drug.