Post on 18-Dec-2015
“Your One and Only Car”
Behavioral Medicine
Centers for Disease Control (CDC) claim that half of the deaths in the US are due to people’s
behaviors (smoking, alcoholism, unprotected sex, insufficient exercise,
drugs, and poor nutrition).
Behavioral Medicine
Psychologists and physicians have thus developed an interdisciplinary field of behavioral medicine that integrates behavioral knowledge with medical knowledge, and applies that knowledge to health and disease
Health Psychology
Health psychology is a field of psychology that contributes to behavioral medicine. The field studies stress-related aspects of disease and asks the following questions:
1. How do emotions and personality factors influence the risk of disease?
2. What attitudes and behaviors prevent illness and promote health and well-being?
3. How do our perceptions determine stress?
4. How can we reduce or control stress?
Stress and Illness Leading causes of death in the US in 1900 and
2000
Stress
Psychological states cause physical illness.
Stress is any circumstance (real or perceived)
that threatens a person’s well-being.
When we feel severe stress, our ability to cope with it is impaired.
Lee Stone/ C
orbis
Stress and Illness
Stress the process by
which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging
When stress is good and leads to something desirable such as studying for a big exam and then receiving a good grade on the exam, it is called eustress.
When the stress has negative effects such as confusion, an inability to make decisions, and illness, it is called distress.
Stress
• THE DOLPHIN STRESS TEST Below is a picture of two dolphins. If you can see both dolphins, your
stresslevel is within the acceptable range. If you see anything other than two dolphins, your stress level is too high and you need to stay home and rest.
And You Think You Have Stress…
Stress and Stressors
Stress is a slippery concept. At times it is the stimulus (missing an
appointment) and at other times it is a response (sweating while taking a test).
Stress and Stressors
Stress is not merely a stimulus or a response. It is a process by which we appraise and cope with
environmental threats and challenges.
When short-lived or taken as a challenge, stressors may have positive effects. However, if stress is threatening or prolonged, it
can be harmful.
The Stress Response SystemCanon proposed that the
stress response (fast) was a fight-or-flight
response marked by the outpouring of
epinephrine and norepinephrine from the
inner adrenal glands, increasing heart and
respiration rates, mobilizing sugar and fat,
and dulling pain.
The Stress Response System
The hypothalamus and the pituitary gland also
respond to stress (slow) by triggering the outer
adrenal glands to secrete glucocorticoids
(cortisol).
Sequence of Steps in the Fight or Flight Behaviors
1. The brain appraises a situation as threatening and dangerous.
2. The lower brain structure secretes a stress hormone.
3. The stress hormone signals the adrenal glands to secrete adrenaline.
4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.
Fight or Flight (Walter Cannon)
The General Adaptation Syndrome (Hans Selye)
Defined as a series of stages the body goes through when exposed to stressful situations.
1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.
2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.
3. The third stage is exhaustion. It is marked by body exhaustion and health problems.
Alarm Resistance Exhaustion
General Adaptation Syndrome
According to Selye, a stress response to any kind ofstimulation is similar. The stressed individual goes
through three phases.
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Stressful Life Events
Catastrophic Events earthquakes, combat stress, floods
Life Changes death of a loved one, divorce, loss of job,
promotion Daily Hassles
rush hour traffic, long lines, job stress, Burnout-- physical, emotional, and mental
exhaustion brought on by persistent job-related stress
Some Psychological Stressors for High School StudentsLife Event Stress Points
Divorce of parents 98
Expulsion from school 79
Major injury or illness 77
Getting a job 62
Major illness of close friend 56
Peer difficulties 45
Moving away 41
Christmas 30
Vacation 25
Traffic ticket 22
Significant Life Changes
The death of a loved one, a divorce, a loss of job, or a promotion may leave individuals
vulnerable to disease.
Perceived Control
Our personal control and optimism is related to stress and our immune system.
With loss of perceived control, we are vulnerable to ill health.
Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.
Perceived Control Health consequences of a loss of control
No connection to shock source
To shock control To shock source
“Executive” rat “Subordinate” rat Control rat
Poverty and Inequality
Poorer people are more at risk for premature death.
People also tend to die younger in areas where there is greater income inequality.
People at every income level are at greater risk of death if they live in a community with great income inequality.
Stress and the Heart
Stress that leads to elevated blood pressure may result in Coronary Heart Disease, a clogging of
the vessels that nourish the heart muscle.
Plaque incoronary artery
Arteryclogged
Stress, Personality, & Heart Disease
Coronary heart disease is North America’s leading cause of death
Habitually grouchy people tend to have poorer health outcomes
Chronic negative emotions have negative effect on immune system
6 factors that increase the risk of heart disease:
1. Smoking
2. Obesity
3. High fat diet
4. Physical Inactivity
5. Elevated blood pressure
6. Elevated Cholesterol + stress and personality
Stress and the Heart
Hopelessnessscores
3.5
3
2.5
2
1.5
1
0.5
0 Heart attack DeathLow risk Moderate risk High risk
Men who feel extreme hopelessnessare at greater risk for heart attacksand early death
Stress and the Heart
Type A Friedman and Rosenman’s term for competitive,
hard-driving, impatient, verbally aggressive, and anger-prone people. Type A personalities are more likely to develop coronary heart disease.
Type B Friedman and
Rosenman’s term
for easygoing, relaxed people
Type A Personality
Type B Personality
Research on type A Personality
Time urgency & competitiveness not associated with poor health outcomes
Negative emotions, anger, aggressive reactivity
High levels of hostility increase chance of all disease (e.g., cancer)
Explanatory style
Optimism use external, unstable, & specific
explanations for negative eventspredicts better health outcomes
Pessimismuse internal, stable, & global explanations
for negative eventspredicts worse health outcomes
Stress and the Heart
Stress and Disease
Psychophysiological Illness “mind-body” illness any stress-related physical illness
some forms of hypertension some headaches
distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease
Stress and Disease
Lymphocytes two types of white blood cells that are
part of the body’s immune system B lymphocytes form in the bone marrow
and release antibodies that fight bacterial infections
T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances
Stress and the Immune System
B lymphocytes fight bacterial infections, T lymphocytes attack cancer cells and viruses, and microphages ingest foreign substances.
During stress, energy is mobilized away from the immune system making it vulnerable.
Lennart Nilsson/ B
oehringer Ingelhein International Gm
bH
Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.
Stress and AIDS
Stress and negative emotions may accelerate the progression from human immunodeficiency virus (HIV) to acquired immune deficiency syndrome
(AIDS).
UN
AID
S/ G
. Pirozzi
Stress and Cancer
Stress does not create cancer cells.
Researchers disagree on whether stress
influences the progression of cancer.
However, they do agree that avoiding stress
and having a hopeful attitude
cannot reverse advanced cancer.
Stress and Immune Conditioning
If the immune system can be suppressed through conditioning, researchers believe that immune-
enhancing responses can be inculcated to combat viral diseases.
Conflict
Conflict arises when a person needs to decide between two alternatives.
Types of conflict:
Approach-Approach
The person is attracted to two
goals.
The approach - approach conflict is not all bad. You have to decide between two attractive choices.
Avoidance - Avoidance
The person has to choose between
them.
The avoidance - avoidance conflict presents two undesirable goals.
Approach - Avoidance
The person is attracted to one goal but it comes
with a negative aspect.
The approach - avoidance conflict can be distressing.
Double Approach - Avoidance
The person has two goals, each has both
good and bad characteristics.
The double approach - avoidance conflict is the most common.
Stress and Disease
Negative emotions and health-related consequences
Unhealthy behaviors(smoking, drinking,
poor nutrition and sleep)
Persistent stressorsand negative
emotions
Release of stresshormones
Heartdisease
Immunesuppression
Autonomic nervoussystem effects
(headaches,hypertension)
Promoting Health
Promoting health is generally defined as the absence of disease. We only think of health when we are diseased. However, health psychologists say that promoting health begins by preventing illness and enhancing well-being, which is a constant endeavor.
Coping with Stress
Reducing stress by changing events that cause stress or by changing how we react to stress is
called problem-focused coping.
Emotion-focused coping is when we cannot change a stressful situation, and we respond by
attending to our own emotional needs.
Explanatory Style
People with an optimistic (instead of pessimistic) explanatory style tend to have more control over stressors, cope better with stressful events, have better moods, and have a stronger
immune system.
Promoting Health
Aerobic Exercise sustained
exercise that increases heart and lung fitness
Depressionscore
14
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10
9
8
7
6
5
4
3 Before treatmentevaluation
After treatmentevaluation
No-treatmentgroup
Aerobicexercise
group
Relaxationtreatment
group
Why Does Exercise Work?
Exercise and MoodReleases chemicals
-- norepinephrine
-- serotonin
-- endorphins
Sense of accomplishment
Improved physique
Why Does Exercise Work?
Exercise and Health
Strengthens heart
Lowers blood pressure
Lowers blood pressure reactivity to stress
Moderate exercise adds two years to one’s expected life.
Promoting Health
Biofeedback system for
electronically recording, amplifying, and feeding back information regarding a subtle physiological state
blood pressure muscle tension
Biofeedback
Feedback about subtle bodily responses e.g., tension in forehead
Not controlling body’s responsesPeople can influence some of these responses
finger temperature forehead tension
Reduce intensity of migrainesHelp with some chronic painRelaxation crucial to biofeedback success
Life-Style
Modifying a Type-A lifestyle may reduce the recurrence of heart attacks.
Relaxation
Meditation can lower blood pressure, heart rate, oxygen consumption
Can it help with stress-related disease?
Social Support
Supportive family members, marriage partners, and close friends help people cope with stress.
Their immune functioning calms the cardiovascular system and lowers blood pressure.
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Managing Stress
Having a sense of control, an optimistic explanatory style, and social support can reduce
stress and improve health.
Spirituality & Faith Communities
Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.
Those who attend religious services experience lower death rates from coronary heart disease.
Spirituality & Faith Communities
Regular religious attendance has been a reliable predictor of a longer life span
with a reduced risk of dying.
Intervening Factors
Investigators suggest there are three factors that connect religious involvement and better health.
Managing Stress: Summary
How can stress be managed?
Promoting Health
Complementary and Alternative Medicine unproven health care treatments not
taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies
Alternative systems ofmedical practice
Bioelectromagneticapplications
Diet, nutrition,life-style changes
Herbal medicine
Manual healing
Mind-body control
Pharmacological and biological treatments
Subfields of Alternative MedicineHealth care ranging from self-care according to folk principles,to care rendered in an organized health care system based onalternative traditions or practices
The study of how living organisms interact with electromagnetic (EM) fields
The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention
Employing plan and plant products from folk medicine traditionsfor pharmacological use
Using touch and manipulation with the hands as a diagnosticand therapeutic tool
Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected-ness of mind and body
Drugs and vaccines not yet accepted by mainstream medicine
Promoting Health Smoking-related early deaths
40,000
30,000
20,000
10,000
0
33,348
1,686 1,135 556 202
Smoking Suicide Vehicle HIV/ Homicide crash AIDS
Cause of death
Numberof deaths
per 100,000
Why Do People Smoke?
The elimination of smoking would increase life expectancy more than any other preventive measure.
1. People smoke because it is socially rewarding.
2. Smoking is also a result of genetic factors.
Why Do People Smoke?
3. Nicotine takes away unpleasant cravings (negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins.
4. Nicotine itself is rewarding (positive reinforcement).
Helping Smokers Quit
Smoking decreased in Western countries, especially in higher socioeconomic groups
and more educated groups.
Ways to Quit Smoking
1. Set a quit date.
2. Inform family and friends.
3. Throw away all cigarettes.
4. Review successful strategies.
5. Use a nicotine patch or gum.
6. Abstain from alcohol.
7. Exercise.
Here are a few pointers on how to quit smoking:
Do Programs Work?
Prevention programs do have an effect on smoking.
Paul J. M
ilette/ Palm
Beach P
ost
Smoking Abstinence Programs
Smoking abstinence programs for teens provide:
1. Information about the effects of smoking
2. Information about peer, parent & media influence
3. Ways to refuse cigarettes
Biopsychosocial Factors: Smoking
Obesity and Weight Control
Fat is an ideal form of stored energy and is readily available. In times of famine, an
overweight body was a sign of affluence.
“You are what you eat”. Eating foods that provide the
biochemical building blocks for those neurotransmitters affect our mood and behavior.
People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.
Nutrition
Body Mass Index (BMI)
Obesity in children increases their risk of diabetes, high blood
pressure, heart disease, gallstones, arthritis, and certain types of cancer,
thus shortening their life-expectancy.
Obesity and Mortality
The death rate is high among very overweight men.
The Physiology of Obesity Fat Cells
A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.
Physiology of Obesity
Fat Cells: There are 30-40 million fat cells in the body. These cells can increase in size or increase in
number (75 million) in an obese individual (Sjöstrum, 1980).
Weight Discrimination
When women applicants were made to look overweight, subjects were less willing to hire
Willingnessto hire scale
(from1:definitely
not hire to7: definitely
hire)
0
1
2
3
4
5
6
7
Women Men
Normal Overweight
Set points and Metabolism
Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.
Metabolism is the rate at which we burn calories.
Set Points and Metabolism
When reduced from 3,500 calories to 450 calories, weight loss was a minimal 6% and the metabolic rate
a mere 15%.
The obese defend their weight by conserving energy.
Losing Weight
Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.
Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.
The Genetic Factor
There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.
Rather, people’s weights resemble those of their biological parents.
Identical twins have closely similar weights, even when reared apart.
The Genetic Factor
Identical twin studies reveal that body weight has a genetic basis.
The obese mouse on the left has a defective gene for the hormone leptin. The mouse on the right sheds 40%
of its weight when injected with leptin.
Activity
Lack of exercise is a major contributor to obesity. Just watching TV for two hours resulted in a 23%
increase of weight when other factors were controlled.
Food Consumption
Over the past 40 years average weight gain has increased. Health professionals are pleading with US
citizens to limit their food intake.
Plan to Lose Weight
When you are motivated to lose weight, begin a weight-loss program, minimize your exposure to tempting
foods, exercise, and forgive yourself for lapses.
Trading Risks
Although cigarette smoking has declined over the years in the Americas, obesity is on the rise.
Weight Control Thinning of Miss America
Weight Control
Most lost weight is regained
-20
-15
-10
-5
0
5
10
1 2 3 4 5
Weightchange
in pounds
Posttreatment
Years of follow-up
Startingpoint
Normal trend for untreated obesepeople: Gradually rising weight
After participation in behavioralProgram: Much of initial weight
loss regained
Weight Control
Obesity was more common among those who watched the most television
<2 2-3 >4Hours of television watched per day
in 1990s study
Boys Girls
32
30
28
26
24
22
20
Skinfold fatmeasure (mm)
HELPFUL HINTS FOR LOSING WEIGHT
• Minimize exposure to tempting food cues• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and your
hunger by changing the food you eat.• Don’t starve all day and eat one big meal at
night.• Beware of the binge.• Set realistic goals.