Health Psychology & Behavioral Medicine

1. Health Psychology & Behavioral Medicine • Health psychology Studies the relationship between psychological factors and physical health • Behavioral Medicine Interdisciplinary field integrating behavioral and medical knowledge Health Psych Division 38

2. Health Psychology True or False • Half the mortality from the 10 leading causes of death is due to people’s behavior • People tend to die younger in lower socio-economic settings • Compared to others, pessimists are more than twice as likely to develop heart disease • Writing about personal traumas in a diary reduces stress and the likelihood of stress-related health problems • Religious faith and health show a strong positive correlation • Smoking a cigarette takes 11 minutes off one’s life expectancy • Genes influence one’s propensity to cigarette addiction

3. Leading Causes of Death 1900 and 2000

4. Health and Stress Stress A state of psychological tension or strain where we respond to life events that we appraise as threatening or challenging.Distress and Eustress Stressors Events or circumstances that trigger stress Adjustment Any attempt to cope with stress

5. Sources of Distress • Everyday Hassles – Specific examples? • Pressure • Frustration • Discrimination* • Conflict* • Extreme Events and Stress • Bereavementand loss • Unemployment • Divorce and separation • Catastrophes • Combat

6. Sources of Stress • Major life changes – Social Readjustment Rating Scale (SRRS) [Holmes & Rahe] • Assesses impact of major life changes • Problems: Adult oriented. Fails to account for different contexts. Individual and cross-cultural limitations • SRSS online • H&R Non-Adult Life Event Scale

7. Daily Hassles:Approach-Avoidance • Opposing Tendencies (Lewin) Four types of AA conflicts • Approach/Approach conflict – When a person is simultaneously attracted to two appealing goals. Conflict arises from choice, e.g.? • Avoidance/Avoidance – When a person is facing two undesirable or threatening choices. “A rock and a hard place” scenario. Examples? • Approach/Avoidance – A person is simultaneously attracted to and repelled by the same situation. Mmmm…cheesecake, fattening • Multiple Approach/Avoidance – Several alternative courses of action with many promising an distressing aspects, e.g. college…

8. Extreme Stress: Psychological Consequences • Post-Traumatic Stress Disorder (PTSD) • Episodes of anxiety, recurrence, sleepless- ness, and nightmares • Victims may withdraw from social life, job and/or family responsibilities • Depression and suicide

9. Stress Reaction • General Adaptation Syndrome (Hans Seyle) • Alarm reaction (sympathetic arousal-need to fight off physical or psychological threats – Cannon’s fight or flight). Epinephrine • Adaptation/Resistance (effort to maintain high level of resistance-attempts to maintain psychological equilibrium. Corticosteroid production. How we measure… • Exhaustion (depletion of reserves) • The body is designed to cope with temporary stress; prolonged stress leads to physical deterioration due to destructive levels of corticosteroids (cortisol) • Parasympathetic reboundcan lead to death

10. The body’s resistance to stress can last only so long before exhaustion sets in Stress resistance Stressor occurs Phase 1 Alarm reaction (mobilize resources) Phase 2 Resistance (cope with stressor) Phase 3 Exhaustion (reserves depleted) Selye’s GAS

11. Stress and Disease • Psycho-physiological illness Stress-related physical illness • Some hypertension, headaches, and gastrointestinal issues • NOT hypochondriasis = misinterpreting physical sensations as symptoms of a disease • Psycho-neuroimmunological disease Interaction between stress and the immune, endocrine, and nervous systems • Chronic stress can suppress immune function. Role of cortisol(lymphocytes) • Possible link between stress and cancer

12. During stress, energy is mobilized away from the immune system AND stress hormones (corticosteroids) reduce lymphocyte production Stress and the Immune System

13. The Brain on Stress • The damaging (and helpful) effects of stress on the brain and cognition (hippocampus & cortisol, emotions and memory, brain-blood barrier, brain degeneration…Assignment) • The Human Brain – Stress • Resource: The Brain: Teaching Modules • Stress and Memory

14. Stress and the Role ofAppraisal “Psychological stress resides neither in the situation nor the person; it depends on the transaction between the two. It arises from how a person appraises an event and adapts to it.” (Lazarus…Remember him?) Stress impact depends on frequency, duration and intensity as well as personality, coping style and events of the day

15. Locus and Loss of Control • Catastrophic events, major life changes, daily hassles and conflicts are especially stressful when perceived as out of one’s control. • Changes in workplace and nursing home settings (Rodin) that increase control result in less stress and illness, and reported higher life satisfaction • Discovering Psych - Health

16. Pessimistic adult men are twice as likely to develop heart disease over a 10-year period (Kubzansky et al., 2001) Pessimism and Heart Disease

17. Optimistic Explanatory Style Those with optimistic (instead of pessimistic) explanatory styles tend to have more control over stressors, cope better with stressful events, have better moods, and have stronger immune systems

18. Stress and Individual Differences • Hardiness A characteristic of people who can tolerate stress well or even thrive on it • Resilience Ability of a person to “bounce back” after a stressful event (Resiliency theory) Resilience Q • Self-imposed stress People who have irrational, self-defeating beliefs that add unnecessarily to the normal stresses of living

19. Socioeconomic and Gender Differences Research findings • Lower socioeconomic status can predict more stressful environments and fewer psychological resources for dealing with stress • Women and men seem to be equally affected by stress physiologically, but deal with it differently (tend and befriend) – role of oxytocin).

20. Stress and Health: Type A and B (and D) Personalities • Type ACompetitive, hard-driving (Friedman and Rosenman). Correlates with heart disease. Primarily due to 1) negative emotions (anger/hostility) and 2) associated behaviors (impatience, verbal aggressiveness, and anger) • Type B More easygoing, relaxed people • Type D Emotionally distressed people. Often characterized by social withdrawal. Correlates with higher rates of stress, disease and death

21. Life events Personal appraisal Challenge Threat Personality type Easy going Nondepressed Optimistic Hostile Depressed Pessimistic Personality habits Nonsmoking Regular exercise Good nutrition Smoking Sedentary Poor nutrition Level of social support Close, enduring Lacking Tendency toward Health Illness Types of Stress Response

22. Direct Coping Direct/Proactive coping Use of intentional methods to address stress Confrontation/Compromise/Withdrawal Anticipate stressful events and take steps to avoid them Positive reappraisal (again, Lazarus) Alter the way you think about a stressful situation or make the best of a tense or stressful event. Importance of humor

23. V. Defensive Coping Defensive coping Occurs when one cannot identify the source of stress or does nothing to change the situation Use of self-deceptive techniques known as defense mechanisms to reduce stress. Types include denial, repression, projection, regression, reaction formation, displacement, and sublimation

24. Methods of Reducing Stress • Calm down • Exercise and healthy lifestyle • Relaxation training (biofeedback) • Meditation • Reach out • Social support network • Religion • Studies have shown an association between religion and lower stress levels • Altruism • Giving to others (do good…) • Shown to be a good way to reduce stress

25. Biofeedback systems use electronic devices to inform people about their physio-logical responses and gives them the chance to bring their response to a healthier range (Neal Miller). Relaxation and meditation have similar effects in reducing tension and anxiety Biofeedback, Relaxation, and Meditation

26. Healthy behaviors (less smoking, drinking) Religious involvement Social support (faith communities, marriage) Better health (less immune system suppression, stress hormones, and suicide) Positive emotions (less stress, anxiety) The Religion Factor

27. Why Do People Smoke? • Social rewards • Genetic factors • Smoking/Nicotine removes unpleasant cravings (aka negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins • Nicotine itself is rewarding (positive reinforcement)