Chapter 8
Psychophysiological Disorders
and
Health Psychology
Ch 8
Psychophysiological Disorders
• Psychophysiological Disorders involve
genuine physical disorders
– Physical symptoms can be caused by or
worsened by emotional distress
– The category recognizes that a broad range of
diseases involving the circulatory, respiratory,
digestive and central nervous systems can be
influenced by stress
Ch 8.1
 Leading Causes of Death (1993)
– Cardiovascular Diseases
– Cancer
– Pulmonary Disease
– Accidents
 Disorders of Lifestyle / Behavior
 Historical Developments
– Psychosomatic Medicine
– Behavioral Medicine
 Apply Behavioral
Science to the
Prevention, Diagnosis,
and Treatment of
Medical Problems
 Interdisciplinary
 Historical Developments
– Psychosomatic Medicine
– Behavioral Medicine
– Health Psychology
 Study Psychological
Factors Important for
the Promotion and
Maintenance of Heath
 Not
Interdisciplinary
 Two Kinds of Influence
 Factors That:
– Lead to Illness and Disease
– Increase Risk of Developing Disease
– Influence Etiology & Maintenance
How Do Psychological and Social
Factors Influence Medical Illness?
Figure 9.2
Psychosocial factors directly affect physical health
Definitions of Stress
• Stress is:
– An environmental condition that may trigger
psychopathology
– A response to environmental conditions that leads to
emotional upset, deteriorating performance or
physiological changes
• Stressors are stimuli
• Cognitive view of stress places emphasis on the
interpretation of external stimuli
– Coping refers to how people deal with stress
Ch 8.2
The General Adaptation
Syndrome
Ch 8.3
Measuring Stress: Social
Readjustment Rating Scale
• The Social Readjustment Rating Scale (SRRS)
– Rates the stressfulness of various life events.
– Initial scale development
• Research participants asked to rate various life experiences
for stress impact (marriage = 500)
• Final version of scale rank orders life events and assigns
proportional score to each event.
– Total score on the scale is correlated with diseases
such as heart attack and leukemia
Ch 8.4
Measuring Stress: Assessment of
Daily Experience Scale
• Assessment of Daily
Experience (ADE,
Stone & Neale, 1982)
– Respondents record
and rate their life experiences
during each day
– Research shows that adverse
life events increase prior to an
illness
Daily Stress & Illness
Figure 8.3
Number of desirable events for the ten
days preceding an episode of
respiratory infection. After Stone, Reed, & Neale,
1987
Figure 8.4
Number of undesirable events in the ten
days preceding an episode of respiratory
infection. After Stone, Reed, and Neale, 1987
 What Influences the Stress Response?
– A Sense of Control
– Coping Skills
– Self-Efficacy
– Health and Wellness Behaviors
– Social Support
– Immune System Functioning
Social Support and Stress
•Karmarck et al. (1995) studied effect of social support on BP in a laboratory
experiment.
•Stress led to increases in both diastolic and systolic blood pressure but BP
increases were greatest when the research participant was alone.
•The stress had less of an impact on BP when participant was accompanied
by a friend.
Biological Theories of the
Stress-Illness Link
•
•
•
Somatic-Weakness theory holds that a
weak organ system may be susceptible
to disruption by stress
Specific-Reaction theory suggests that
people respond to stress in unique
ways, some organ systems show
greater reactivity than do other
systems
Allostatic load (McEwen & Seeman,
1999)
– When stressors are acute or occur
repeatedly, the biological
responses to stress (e.g., cortisol
secretion) can an have aversive
impact on body.
– Over time, stress response itself
may overwhelm the system
Ch 8.5
Stress and the Immune
System
Psychological Theories of the
Stress-Illness Link
• Psychoanalytic view holds that specific
conflicts give rise to psychophysiological
disorders
• Cognitive-Behavioral view proposes that
humans have higher cognitive functions
which can amplify and extend the duration
of arousal of our bodies
Ch 8.6
Hypertension
• Hypertension is high blood pressure (bp)
– Hypertension leads to heart attacks and
strokes
• Systolic bp is arterial pressure during contraction of
the ventricles of the heart
• Diastolic bp is arterial pressure during relaxation of
the ventricles of the heart
– Increased bp is brought on by increased
cardiac output (more blood leaving the heart)
or by vasoconstriction of the arteries
Ch 8.7
Stress and BP
• Stressful conditions produce a short-term
increase in blood pressure
– These increases return to baseline when the stressor
is withdrawn
• Studies of blood pressure done on ambulatory
subjects reveal that anger is most strongly linked
to elevated bp
– The changes were large in a subset of subjects
– Reactivity refers to increased bp and heart rate in
response to stress
Ch 8.8
Coronary Heart Disease
• Coronary Heart Disease refers to
– Angina pectoris: periodic chest pains
• Reduced oxygen supply to heart
– Myocardial infarction: heart attack
• Brought on by a cutoff of oxygen to the heart muscle
• Risk factors for MI include age, gender (males), elevated
blood pressure, elevated cholesterol, obesity, physical
inactivity, excessive use of alcohol and diabetes
Ch 8.9
Diatheses for Coronary Heart
Disease
• Psychological diatheses for CHD include:
– Type A behavior pattern (time urgency, competitive,
aggressive/hostile)
– High levels of anger
– Cynicism
– Type D personality: high levels of anger, anxiety and
depression as well as low levels of emotional
expression
• Biological diatheses: focus is on reactivity
Ch 8.10
Asthma
• Characteristics: air passages suddenly
narrow, breathing becomes hard (wheezy)
• Triggered by allergens, pollution, viruses,
cold, and emotional states
• Dominant Etiologic Factor (Rees, 1964)
– Allergic (23%)
– Infective (38%) (but 86% had had infection)
– Psychological (37%)
AIDS
• AIDS
– Is a fatal disease caused viral infection
– Compromises the immune system
• AIDS
– May arise from irrational and self-defeating behavior
– Is treatable, but not presently curable or preventable
by medical means
– Is preventable by psychological means
Ch 8.11
Gender & Health
•
Mortality rates
•
•
Higher for men at every age
Men more likely to die
–
–
•
Why differential mortality rates?
–
–
–
Hormones may confer protection against life threatening diseases.
Men more likely to be Type A which may increase risk of heart disease.
• However, recent research indicates that women may be as prone to anger as men.
Lifestyle differences such as increased consumption of alcohol.
• Lifestyle differences may be narrowing
–
•
•
Women drink more alcohol and smoke more than in the past.
Morbidity rates
–
•
In auto accidents or by homicide
Of cirrhosis, heart & lung disease, lung cancer, & suicide
Higher for women
• Women more likely to
–
–
Have specific diseases such as diabetes, rheumatoid arthritis, etc.
Visit physicians and use prescription drugs
Why differential morbidity rates?
•
•
•
•
•
Women live longer and therefore may be more likely to develop diseases associated with aging.
Women more likely to visit physicians, therefore increasing the likelihood that the diseases they experience
are reported to health tracking agencies.
Women experience more stress than men, and rate stress as having a greater impact.
MD’s may treat women’s health concerns less seriously than men’s health concerns
Lower levels of women’s income seem to play a role as does ethnicity.
Research studies on health and stress should include women and men in equal numbers
Socioeconomic Status, Ethnicity,
& Health
• Low SES is associated with higher rates of mortality from
all causes
• Disease and mortality rates differ by race and ethnicity
(perhaps due to association with low SES)
• What factors may account for this relationship?
–
–
–
–
Environmental factors
Increased stressors
Limited access to health services
Unable to afford medical insurance & health care
• Biological/genetic differences in incidence of illness may
be mediated by behavioral variables (e.g., diet and
lifestyle)
Therapies for
Psychophysiological Disorders
• Drug interventions can be used to reduce the
physical symptoms brought on by stress
• Reduction of anxiety, depression or anger is a key
element in the treatment of stress-related disorders
– Psychoanalysis: uses free association
– Cognitive/behavioral: uses systematic desensitization, in
vivo exposure, assertion training
Ch 8.12
Treating Hypertension
• Non-pharmacological treatments include:
– Losing weight
– Reducing salt intake
– Giving up smoking
– Limiting alcohol intake
– Getting regular exercise
– Relaxation training
– Reducing anger
Ch 8.13
 Psychosocial Link to Disease
– AIDS
– Cardiovascular Diseases
– Cancer
– Chronic Pain
– Chronic Fatigue Syndrome
– Treatment and Outcome
 The Field of Psychological Oncology
– Stress Reduction Prolongs Life
– Psychological Factors Influence
– Course and Development
– Response to Aversive Medical Treatment
– Improve Quality of Life
– Slow Disease Progression
– Psychological Factors are Not Cures!
 Psychosocial Link to Disease
– AIDS
– Cardiovascular Diseases
– Cancer
– Chronic Pain
– Chronic Fatigue Syndrome
– Treatment and Outcome
 The Nature of Chronic Pain
– $100 Billion Spent on Main Medication in U.S.
– Worldwide, 20 Million Tons of Aspirin
 Two Kinds of Clinical Pain
– Acute Pain
– Chronic Pain
 Psychological and Social Dimensions
– Pain Severity Does not Predict One’s Reaction
– Differences Are Psychological
 Biological Dimensions
– Gate Control Theory
– Endogenous Opiods (“Endorphins”)
 Phantom Limb Pain
 Psychosocial Link to Disease
– AIDS
– Cardiovascular Diseases
– Cancer
– Chronic Pain
– Chronic Fatigue Syndrome
– Treatment
 The Nature of Chronic Fatigue
– Unexplained Fatigue
– Variety of Physical Symptoms
– Most Common in Women
– Often Debilitating
 Psychosocial Link to Disease
– AIDS
–Cardiovascular Diseases
– Cancer
– Chronic Pain
– Chronic Fatigue Syndrome
– Treatment and Outcome
 Available Treatments
– Biofeedback
– Relaxation Procedures
– Hypnosis
– Comprehensive Stress Management
 Obstacles to Treatment
– Denial and Noncompliance
 Prevention Efforts
Stress Management
• Stress Management is a set of techniques used to
cope with stress
– Arousal can be reduced through relaxation training or by
biofeedback
– Cognitive restructuring can be used to alter the thought
patterns of a person and to increase their perceived level
of control
– Behavioral skills training relating to time management and
how to prioritize
– Train the person in how to alter their environment
Ch 8.14
Pain Management
• Pain can be modified by
– Distraction
– Refocusing attention
– Lowering anxiety
– Effecting a sense of control over pain
– Re-labeling the sensation as tickling or numbness
– Use of biofeedback
• Sensitive instruments that give information about
psychophysiological states (e.g., skin temp.,
muscle tension, EEGs) to increase voluntary
control
Ch 8.15