Psycho Physiological Disorders
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Transcript of Psycho Physiological Disorders
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Psychophysiological disorders
Lecture 1
In these 2 lectures we will cover..
• definition of psychophysiological disorder
• definition and measurement of “stress”
• physiological explanations of stress response
• personaility factors affecting response to stress
• behavioural and cognitive factors affecting
response to stress
DIATHESIS-STRESS
• constitutional predisposition
triggered by
• environmental stress
PSYCHOPHYSIOLOGICAL disorders
• psychological/emotional factors which predisposeindividuals to develop physical illness
• DSM IV-R
Axis I “psychological factors affecting medicalcondition”
stress...
• Lazarus 1968
“STRESS OCCURS WHEN A SITUATION IS
APPRAISED AS EXCEEDING A PERSON’S
ADAPTIVE RESOURCES”
• ... not the situation/environment per se, but the
way the person interprets the experience
An exam situation...
...stress is produced when
• She perceives the result as an importantdeterminant of her success
• she perceives it as taxing or exceeding her abilityto prepare for and complete it successfully
• perception of the demands in relation to personalresources – and strategies available to deal withthem
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Moderators of stress
• Coping strategies (problem focused, emotion
focused)
• Social support (structural, functional - critically
NONEVALUATIVE)
• Social conflict predicts poor outcome in people
with coronary heart disease
• Social isolation confers heightened risk for
coronary heart disease
Measuring stress
• Life Change Units - Combine life event frequencyand intensity/salience
• Life event = something which demands resourcesand requires personal or social adjustment
• divorce or vacation +ve or –ve
• LCU calculated for a particular period of time byadding weighted scores of events experienced
Categories of ‘stressor’
• Life events
• Holmes & Rahe (1967): SCHEDULE OFRECENT EVENTS
• Daily Hassles?
• ... unwanted visitors, parking tickets, no milk inthe fridge.
• Population specific- daily hassles for collegestudents (Kohn et al 1990)
Traumatic stress...
• Higher death rate in
widowers within 6 months
of death of spouse
(relative to age-related
norms)
• Higher incidence of
hospital visits and 19%
increase in death rate
following Mt St Helens
eruption in 1980….
The “weak link in the chain”
• no evidence that different psychological stressors
relate to different physical disorders –
• individual’s constitutional vulnerability
determines the organ/system ‘reactive’ to stress
• stomach.. skin ..lungs ..heart
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Explaining psychophysiological
responses to stress
• Stress produces specific adverse physiological
reactions and direct damage to the body
• Stress damages the body indirectly by increasing
unhealthy behaviours
• Stress induces unhealthy cognitions and
behaviours in certain personality types, making
them vulnerable to physical illness
Physiological explanations
• emphasis on causal role of constitutional reactivity
• stem from evolutionary model –
• response to psychological threat mimics evolutionary response
to physical threat - increased b/p, muscle tension, respiratory
changes
• These have become automatic responses to psychological
stress
• often maladaptive – counterproductive – debilitating
Selye (1976)
General Adaptation syndrome
Damage may be caused by different
routes:
• inherited physiological reactivity in Autonomic
Nervous System
• specific organ vulnerability - inherited
• individual biological reactions - inherited/acquired
• immune system changes
physiological reactivity
Fewer
hippocampal
neurons
More
cortisol
secretion
Destruction of hippocampal neurons
Decreased ability to shut of cortisol secretion
Prolonged stress
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Immune system changes
Psychoneuroimmunology
Studying evidence for stress-related loweringof body’s resistance to infection/virus
“immunocompetence” = immune systemefficiency
in animals... Sklar & Anisman (1979)
• introduced cancerous growths into 2identical sets of mice
• half exposed to intermittent electric shock
• Cancerous tumours developed more rapidlyin stressed group
in humans...
• reduced efficiency of immune system
(Kiecolt-Glaser & Glaser, 1970s, 80s, 90s)
• colds and stress
• depression
• unemployment
• marital disruption
• bereavement
two possible mechanisms
• Natural killer cell: cytotoxicity significantly
diminished by induced negative self evaluations
(Strauman et al 1993)
• Efficiency of natural DNA repair systems: reduced
by stress (Glaser et al 1985)
coronary heart disease
• Most widely researchedpsychophysiological disorder
• Consider a) unhealthy behaviours and b)personality traits/cognitions in relation toCHD
Coronary heart disease
• ARTERIOSCLEROSIS - thickening and
stiffening of coronary arteries, often a
consequence of chronic hypertension
• ATHEROSCLEROSIS – thickening of coronary
arteries by deposition of cholesterol
• MYOCARDIAL INFARCTION - heart attack
- death of tissue as a result of lack of oxygen
following blockage in coronary artery
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physiological risk factors for CHD...
• Growing old
• Being male
• Smoking cigarettes
• Physical inactivity
• Having high serum
cholesterol
• Enlarged left ventricle
• Diabetes
• Having high blood
pressure
high blood pressure
• Approximately 25 million individuals have elevated
blood pressure.
• Consistent or frequent elevation = HYPERTENSION
• 92-98% of those suffering from hypertension show no
discernible organic cause
• ESSENTIAL / PRIMARY HYPERTENSIVES
• For this group, environmental stress plays a
critical role in development of hypertension
• high stress jobs + high basal blood pressure
and/or cardiovascular reactivity = essential
hypertension risk
Personality as a risk factor?
• first suggested by Friedman (1969) and Friedman
and Rosenman (1974)
• described individual with a CORONARY-
PRONE personallity...
a TYPE A individual
“any person who is aggressively involved in a
chronic incessant struggle to achieve more
and more in less and less time”
typical Type A individual...
• ..is competitive and ambitious
• ..has exaggerated sense of time urgency
• ..is aggressive and hostile
• ..is over-committed to work
• (characteristics may emerge as early as 3-4 yrs old)
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• Others not displaying these characteristics are
classified by default as Type Bs – relaxed, serene,
no sense of time urgency
Type A/B can be differentiated by
questionnaire or interview..
• Structured interview: affective/expressive styleand behaviour
Rosenthan et al (1964)
• Jenkins Activity Survey: self report
Jenkins (1968)
TRAIT vs REPONSE STYLE
• first considered as a fixed set of traits – maybe more appropriate to think of it asRESPONSE STYLE
• not invariant overt behaviour pattern –situational
• differs between populations - not allenvironments induce it
• High percentage are white middle income,middle class males
• embedded within social context ofcompetitive occupational careers in US andsimilar cultures
• in this setting may be highly adaptiveresponse style leading to desired materialgoals
Situation dependent style –
• Ratings drop radically in 50 somethings
• Bages et al (1997) – 45 University employees
• Asked participants, spouses and work supervisors
to assess Type A behaviour, anger, social support
measures in their respective environments
• Home environment: Participants andspouses agreed on all measures.
• Work environment: Participants and worksupervisors agreed on Type A assessment
• Spouses vs Work supervisors: virtually nooverlap
• situation specific Type A Behaviour Pattern