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)Leading Causes of Death (1993)– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Pulmonary DiseasePulmonary Disease– AccidentsAccidents

Disorders of Lifestyle / BehaviorDisorders of Lifestyle / Behavior

Leading Causes of Death (1993)Leading Causes of Death (1993)– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Pulmonary DiseasePulmonary Disease– AccidentsAccidents

Disorders of Lifestyle / BehaviorDisorders of Lifestyle / Behavior

Historical DevelopmentsHistorical Developments Historical DevelopmentsHistorical Developments– Psychosomatic MedicinePsychosomatic Medicine– Psychosomatic MedicinePsychosomatic Medicine

– Behavioral MedicineBehavioral Medicine– Behavioral MedicineBehavioral Medicine

Apply Behavioral Apply Behavioral Science to the Science to the Prevention, Diagnosis, Prevention, Diagnosis, and Treatment of and Treatment of Medical ProblemsMedical Problems

InterdisciplinaryInterdisciplinary

Apply Behavioral Apply Behavioral Science to the Science to the Prevention, Diagnosis, Prevention, Diagnosis, and Treatment of and Treatment of Medical ProblemsMedical Problems

InterdisciplinaryInterdisciplinary

Historical DevelopmentsHistorical Developments Historical DevelopmentsHistorical Developments– Psychosomatic MedicinePsychosomatic Medicine– Psychosomatic MedicinePsychosomatic Medicine

– Behavioral MedicineBehavioral Medicine– Behavioral MedicineBehavioral Medicine

– Health PsychologyHealth Psychology– Health PsychologyHealth Psychology

Study Psychological Study Psychological Factors Important for Factors Important for the Promotion and the Promotion and Maintenance of HeathMaintenance of Heath

NotNot InterdisciplinaryInterdisciplinary

Study Psychological Study Psychological Factors Important for Factors Important for the Promotion and the Promotion and Maintenance of HeathMaintenance of Heath

NotNot InterdisciplinaryInterdisciplinary

Two Kinds of InfluenceTwo Kinds of Influence Two Kinds of InfluenceTwo Kinds of Influence

– Lead to Illness and DiseaseLead to Illness and Disease– Lead to Illness and DiseaseLead to Illness and Disease

– Increase Risk of Developing DiseaseIncrease Risk of Developing Disease– Increase Risk of Developing DiseaseIncrease Risk of Developing Disease

– Influence Etiology & MaintenanceInfluence Etiology & Maintenance– Influence Etiology & MaintenanceInfluence Etiology & Maintenance

Factors ThatFactors That:: Factors ThatFactors That::

How Do Psychological and SocialFactors 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 8.4Number of undesirable events in the ten days preceding an episode of respiratory infection. After Stone, Reed, and Neale, 1987

What Influences the Stress Response?What Influences the Stress Response? What Influences the Stress Response?What Influences the Stress Response?– A Sense of ControlA Sense of Control– Coping SkillsCoping Skills– Self-EfficacySelf-Efficacy– Health and Wellness BehaviorsHealth and Wellness Behaviors– Social SupportSocial Support– Immune System FunctioningImmune System Functioning

– A Sense of ControlA Sense of Control– Coping SkillsCoping Skills– Self-EfficacySelf-Efficacy– Health and Wellness BehaviorsHealth and Wellness Behaviors– Social SupportSocial Support– Immune System FunctioningImmune 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

– In auto accidents or by homicide– Of cirrhosis, heart & lung disease, lung cancer, & suicide

• 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– 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 DiseasePsychosocial Link to Disease Psychosocial Link to DiseasePsychosocial Link to Disease– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

The Field of Psychological OncologyThe Field of Psychological Oncology The Field of Psychological OncologyThe Field of Psychological Oncology– Stress Reduction Prolongs LifeStress Reduction Prolongs Life – Psychological Factors InfluencePsychological Factors Influence

– Course and DevelopmentCourse and Development– Response to Aversive Medical TreatmentResponse to Aversive Medical Treatment– Improve Quality of LifeImprove Quality of Life– Slow Disease ProgressionSlow Disease Progression

– Psychological Factors are Not Cures!Psychological Factors are Not Cures!

– Stress Reduction Prolongs LifeStress Reduction Prolongs Life – Psychological Factors InfluencePsychological Factors Influence

– Course and DevelopmentCourse and Development– Response to Aversive Medical TreatmentResponse to Aversive Medical Treatment– Improve Quality of LifeImprove Quality of Life– Slow Disease ProgressionSlow Disease Progression

– Psychological Factors are Not Cures!Psychological Factors are Not Cures!

Psychosocial Link to DiseasePsychosocial Link to Disease Psychosocial Link to DiseasePsychosocial Link to Disease– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

The Nature of Chronic PainThe Nature of Chronic Pain The Nature of Chronic PainThe Nature of Chronic Pain– $100 Billion Spent on Main Medication in U.S.$100 Billion Spent on Main Medication in U.S.– Worldwide, 20 Million Tons of AspirinWorldwide, 20 Million Tons of Aspirin – $100 Billion Spent on Main Medication in U.S.$100 Billion Spent on Main Medication in U.S.– Worldwide, 20 Million Tons of AspirinWorldwide, 20 Million Tons of Aspirin

Two Kinds of Clinical PainTwo Kinds of Clinical Pain Two Kinds of Clinical PainTwo Kinds of Clinical Pain– Acute PainAcute Pain– Chronic PainChronic Pain– Acute PainAcute Pain– Chronic PainChronic Pain

Psychological and Social DimensionsPsychological and Social Dimensions Psychological and Social DimensionsPsychological and Social Dimensions– Pain Severity Does not Predict One’s ReactionPain Severity Does not Predict One’s Reaction– Differences Are PsychologicalDifferences Are Psychological– Pain Severity Does not Predict One’s ReactionPain Severity Does not Predict One’s Reaction– Differences Are PsychologicalDifferences Are Psychological

Biological DimensionsBiological Dimensions Biological DimensionsBiological Dimensions– Gate Control TheoryGate Control Theory– Endogenous Opiods (“Endorphins”)Endogenous Opiods (“Endorphins”)– Gate Control TheoryGate Control Theory– Endogenous Opiods (“Endorphins”)Endogenous Opiods (“Endorphins”)

Phantom Limb PainPhantom Limb Pain Phantom Limb PainPhantom Limb Pain

Psychosocial Link to DiseasePsychosocial Link to Disease Psychosocial Link to DiseasePsychosocial Link to Disease– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– TreatmentTreatment

– AIDSAIDS– Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– TreatmentTreatment

– Unexplained FatigueUnexplained Fatigue– Variety of Physical SymptomsVariety of Physical Symptoms– Most Common in WomenMost Common in Women– Often DebilitatingOften Debilitating

– Unexplained FatigueUnexplained Fatigue– Variety of Physical SymptomsVariety of Physical Symptoms– Most Common in WomenMost Common in Women– Often DebilitatingOften Debilitating

The Nature of Chronic FatigueThe Nature of Chronic Fatigue The Nature of Chronic FatigueThe Nature of Chronic Fatigue

Psychosocial Link to DiseasePsychosocial Link to Disease Psychosocial Link to DiseasePsychosocial Link to Disease– AIDSAIDS–Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

– AIDSAIDS–Cardiovascular DiseasesCardiovascular Diseases– CancerCancer– Chronic PainChronic Pain– Chronic Fatigue SyndromeChronic Fatigue Syndrome– Treatment and OutcomeTreatment and Outcome

– BiofeedbackBiofeedback– Relaxation ProceduresRelaxation Procedures– HypnosisHypnosis– Comprehensive Stress ManagementComprehensive Stress Management

– BiofeedbackBiofeedback– Relaxation ProceduresRelaxation Procedures– HypnosisHypnosis– Comprehensive Stress ManagementComprehensive Stress Management

Available TreatmentsAvailable Treatments Available TreatmentsAvailable Treatments

Obstacles to TreatmentObstacles to Treatment Obstacles to TreatmentObstacles to Treatment– Denial and NoncomplianceDenial and Noncompliance– Denial and NoncomplianceDenial and Noncompliance

Prevention EffortsPrevention Efforts Prevention EffortsPrevention 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