Psychophysiological disorders are illnesses influenced by emotional
factors
Widely diverse medical conditions are affects, if not caused by
psychological factors
DSM-IV and DSM-IV-TR have a comprehensive category
that may be applied to any illness
Researchers recognize that physically caused illness can cause
stress, which affects course of illness
Health psychology reflects holistic concept of body and mind
Mind and Body
Mind/Body Problem
Refers to question of relationship between mind and body
Historically, mind and body were seen as separate, as in dualism
Plato originated idea
Laid foundation of modern science rationalism; nature explained
through empirical evidence
Organic causation was the rule in explaining illness
Once thought involuntary, physiological functions could be influenced
voluntarily
Mind and body are one; psychological and physical refer to different
ways of talking about same phenomenon
Psychological Stress
Defining Stress
Stress can be defined as a stimulus: stress consists
of environmental demands that lead to physical responses
Stress can be defined as response; general adaptation syndrome
with three stages
Stress can be defined as interaction between stimulus and
person's appraisal of it
What Determines Responses to Stress?
Stimulus Specificity
Stimulus specificity refers to different kinds
of stress that produce different kinds of physiological responses
Subtle distinctions can be made; reactions differ if
we are expecting a stressful event or are undergoing the event
Reactions are very complex since different stressors
produce different patterns of responses
Individual Response Specificity
People have characteristic patterns of physiological response
called individual response specificity
Some people respond to stress more intensely
Stimulus Versus Individual
Person and stressor operate simultaneously
Degree of increase and decrease subject to individual
response specificity
How Stress Influences Illness
Connection exists between stress and illness
Changes in Physiological Functioning
Stress and the Autonomic Nervous System
ANS controls smooth muscles, glands, and internal organs
Sympathetic division mobilizes body; parasympathetic
division returns body to resting state
ANS contributes to fight-or-flight response
Changes in the Immune System
Immune system is body's system of defense against
infectious disease and cancer
Psychoneuroimmunology is the study of the immune
system's link between stress and illness
Studying subjects following naturalistic major events,
minor events, and laboratory stressors suggests decreases
in cellular immunity and reduced immune functioning
Feedback Loops
Body systems provide feedback or information about
relating the system
Negative feedback is important in theories of
stress and illness
Disregulation model argues that stress-related illness
occurs when there is disruption in negative feedback
Oscillations are rhythmic back-and-forth cycle of body
systems
Stress may disrupt rhythms affecting other systems
Changes in High-Risk Behavior
Stress may cause people to adopt behavior that puts them at
risk of illness
Stress can interfere with preventive measure against disease
Stress may encourage its victims to report illness
Psychological Factors and Physical Disorders
Coronary Heart Disease (CHD)
Coronary heart disease (CHD) caused by atherosclerosis
and manifested as heart attack or sudden cardiac death
A number of risk factors have been identified
Link exists between social environment/status and atherosclerosis
Relationship between social and occupational stress and development
and progression of coronary heart disease
Cardiovascular reactivity thought to contribute to development
and expression of coronary heart disease
Research suggests relationship between some qualities (e.g., hostility,
anger) seen in Type A people and heart disease
Hypertension
Chronically high blood pressure is known as hypertension
Hypertension increases risk for other cardiovascular disorders
The regulatory mechanism involving feedback breaks down and blood
vessels remain chronically constricted
Essential hypertension occurs where there is no known organic
cause
Hypertensives may live in environments where stimuli that
increase blood pressure are common
Individual response specificity may play role in essential
hypertension
Many people with hypertension are unaware of the condition
Cancer
Cancer is associated with psychological stress
Social support and group therapy help patients with breast cancer
and malignant melanoma
Active coping may be a benefit of group therapy
AIDS
Acquired immune deficiency syndrome (AIDS) is caused by the human
immunodeficiency virus (HIV)
Virus, found in several bodily fluids, attacks the immune system,
leaving the person open to various infections (e.g., Kaposi's sarcoma)
The relationship between stress and the course of AIDS is unclear
Avoidance behavior has been seen as a benefit of psychological
treatment
Headache
Migraine headaches and muscle-contraction headaches
are related to stress but differ from each other in several ways
Theories of migraine have shifted away from psychological to organic
causes
Involves dysfunction in operation of serotonin
Precise nature of serotonin dysfunction is not known
Genetic, hormonal factors may play role
Stress can trigger migraine headache
Obesity
Eating behavior can be affected by disruption in the normal regulatory
cycle
Anorexia nervosa is extreme malnourishment
Obesity, as a socially defined condition, refers to an
excessive amount of fat on the body
Physical and social consequences of obesity
Genetic differences and behavioral differences contribute to obesity
Obesity also due to interaction of physiological and psychological
factors such as more responsiveness to taste of food and problem of
feedback from stomach to brain
Weight-loss programs shifting emphasis from dieting to exercise
Most effective programs focus on several components
Some have argued for a more broad definition of physical attractiveness
Sleep Disorders
Insomnia
Insomnia is the chronic inability to sleep
There are three broad patterns of insomnia--problems with
falling asleep, awakening repeatedly during night, waking up too
early
Concern for sleep disturbance leads to anticipatory anxiety
Many factors are related to insomnia such as drugs, alcohol,
and stress
The definition of sleep affects whether insomniacs are actually
sleeping
Hypnotics are used, which cause several problems
Altering architecture of sleep leading to REM rebound
Withdrawal from drug leads to insomnia
An illegal market for benzodiazepines has emerged
A new hypnotic may be promising, with fewer side effects
Most hypnotics are not effective over the long term
Circadian Rhythm Disorders
Circadian rhythm disorders occur when people try to
sleep at times that are inconsistent with their circadian rhythms
Common among shift workers but not limited to them
Target bedtime and light therapy appear to be effective treatments
Groups at Risk
Gender
Risk for coronary heart disease is higher among men
May be due to reproductive hormones
May be due to men more likely to engage in potentially health-damaging
behaviors
Others suggest gender differences in experience of stressors
Race
African-Americans have higher rates for hypertension, as well
as morbidity and mortality rates for several disorders
Data on racial differences in cardiovascular disorders are unclear
Socioeconomic status and race are related
Socioeconomic Status (SES)
Socioeconomic status is a factor in determining health
Association may be function of greater emotional impact of stressful
life events
Socioeconomic status affects development and progression of coronary
heart disease
Work environment where there is low control over decisions and
low skills requirements may be important
A relationship may exist between survival and recovery and socioeconomic
status
Stress and Illness: Theory and Therapy
The Behavioral Perspective
Respondent versus Operant
Respondent conditioning can have powerful effect on physiological
responses
Physiological responses (e.g., blood pressure, urine formation)
can be modified by operant conditioning
Learning could operate in development of physical disorders
Learning can be used to relieve the disorder
Biofeedback, Relaxation, and Exercise
Biofeedback training can give patients ability to control
physiological functions
Patients given immediate feedback in biofeedback training
Relaxation training used extensively in stress-relief
programs; uses progressive relaxation
Exercise may be effective in reducing stress
The Cognitive Perspective
Predictability and Control
Predictable stimuli are less stressful than unpredictable
stimuli
Control helps to reduce stress
Coping can solve problems that create stress; it can also
affect our physiological response to stress
Coping is connected to cognitive processes and is determined
by cognitive styles
Lazarus's model sees stress as a dynamic reciprocal, interactive
relationship involving six basic factors
Environmental event
Primary appraisal of event
Secondary appraisal
Coping
Outcomes of coping
Health outcomes
Stress Management Intervention
Goal of stress-management programs is to pinpoint the sources
of stress and to build skills to cope with stressors
People taught muscle relaxation,
Programs developed for Type A's, cardiac rehabilitation programs
Cognitive-behavioral stress-management programs developed
and include relaxation training, cognitive restructuring, assertiveness
training, and health education
The Psychodynamic Perspective
Psychological Inhibition
Refers to stress-related physical disorders such as organ
neuroses
Disorders caused by repression, anxiety, and defense
Family interactions central to stress-related physical disorders
Inhibition of expression of emotion, behavioral, and social
impulses contributes to development of "psychosomatic" disorders
The Value of Catharsis
Research confirms value of emotional catharsis to physical
health
Journaling may have effect on immune system by allowing expression
of negative emotion
The Interpersonal Perspective
Major source of physical illness is the stress imposed by modern
industrial society
No regular social support prevents protection against illness
Strong evidence to show that people without social support are
more prone to disease
Marital status is a risk factor for physical illness
The Sociocultural Perspective
Changes in society affect susceptibility of certain groups to
particular illnesses
Gender and race are important risk factors
The Neuroscience Perspective
Genetic Predisposition
Stress-related physical disorders tend to run in families
Early identification of those at risk is important
PNI and Interactive Theories
Different perspectives represent differences of focus
