7a - Psychobiology (06.03.2020)

Question 1

What is stress?

Answer 1

• Stress can be a stimulus
• Events that place strong demands on us are known as stressors
• For example, the approaching exam period is a potential stressor
• Stress can be a response
• Physiological response to stress e.g. ‘Fight-Flight’ response
• Also, the presence of negative emotions including feeling tense, difficulty concentrating and losing your temper easily (behavioural as well was physiological emotional impacts)

Question 2

What happens in a stress response?

Answer 2

• acticvation of the SNS (increased HR, blood redistribution to skeletal muscle, increased blood flow to certain areas and decreased to others e.g. gut, urge to urinate or defecate, pupils dilate etc.)
• increased A and NA from adrenal medulla
• also activation of the HPA axis: production of stress hormones (ACTH -> cortisol)

Look at the diagram

Question 3

General Adaptation Syndrome

Answer 3

3 Stages of stress

1: alarm reaction (shift to SNS dominance)
2: resistance (endocrine system releases stress hormones)
3: exhaustion (adrenal glands lose their ability to function normally)

Question 4

Definition of stress

Answer 4

• Combination of stimulus and response as a person-situation interaction
• Stress can be defined as a pattern of cognitive appraisals, emotional reactions, physiological responses and behavioural tendencies that occur in response to a perceived imbalance between situational demands (primary appraisal) and the resources needed to cope with them (secondary appraisal).

Question 5

Cognitive appraisal

Answer 5

• e.g. when considering an exam you will evaluate how hard it will be and how much it counts (primary appraisal) and how your current knowledge equips you to pass (secondary appraisal)‏
• You will also take into account potential consequences of failing with regards to their likelihood and seriousness
• Finally, the psychological meaning of the consequences may be related to your beliefs about yourself or the world, e.g. “I am a total failure if I don’t do well in all my exams”

Question 6

Appraisal and stress in a health sitation

Answer 6

A:

Question 7

Yerkes-Dodson Law

Answer 7

• there is an optimal level of arousal for performance

- under and overarousal is bad

Question 8

Pathways from stress to disease

Answer 8

• events -> stress -> behavioural changes -> disease
• events -> stress -> physiological changes -> disease
• (e.g. different behaviour in exam period e.g. more smoking, less exercise; perceived level of social support is also there: stressful time and high support smoke less than baseline and low perceived support smoke more than baseline)

Question 9

Pathways from stress to disease

Answer 9

• events -> stress -> behavioural changes -> disease
• events -> stress -> physiological changes -> disease
• (e.g. different behaviour in exam period e.g. more smoking, less exercise; perceived level of social support is also there: stressful time and high support smoke less than baseline and low perceived support smoke more than baseline)

Question 10

Anxiety and heart disease

Answer 10

• A recent meta-analysis found anxiety was associated with a 52% increased risk of developing CVD
• This increased risk was independent of traditional risk factors (e.g. smoking, obesity, high BP) and depression
• Anxiety management could therefore be a target for future CVD risk reduction

Question 11

Psychosocial stress and coronary heart disease

Answer 11

• 514 healthy men and women without history or objective signs of CHD
• Cortisol was measured in response to mental stressors (cognitive task)
• Measured the degree of coronary artery calcification (CAC)
• Conclusion: heightened cortisol reactivity is associated with a greater extent of CAC.

-> high levels fo cortisol reactivity -> high levels of calcification

Question 12

Mucosal wound healing and exam stress (Marucha et al 1998)‏

Answer 12

• Method: Dental students were each administered two punch biopsy wounds on the hard palate. One during the summer vacation and one before a major exam.
• Measures: daily photographs of wounds
• The wounds took an average of 40% (3 days) longer to heal during the examinations.
• All students had slower healing during exams
• Mechanism? Production of Interleukin-1 declined by 68% during the exam.

Question 13

Type A Behaviour

Answer 13

• Time urgency
• Free-floating hostility
• Hyper-aggressiveness
• Focus on accomplishment
• Competitive and goal-driven

Question 14

Personality type ad CHD

Answer 14

• Western Collaborative Group Study followed >3000 males for 8.5 yrs. TABP doubled the risk of developing CHD in healthy males (aged 39 -59) when cardiac risk factors controlled for (Rosenman et al. 1975)‏
• When compared to Type B, characterised by patience, serenity and lack of time urgency, Type A behaviour alone accounted for 31% increase in risk (Brand et al. 1976)‏
• additional risk for CHD in people with Type A personality; significant increase in risk.

Question 15

What makes type A peronality people more vulnerable to CHD?

Answer 15

• Later studies highlighted central role of hostility as key ‘Type A’ behavioural factor with relationship to CHD
• Mechanism ?Poor health behaviours ?Increased physiological response to stressor -> endothelial dysfunction -> atherosclerosis
• Recent studies of ‘Type D behaviour’, characterised by social inhibition and negative affect, showed a relationship with CHD, possibly due to under-reporting of symptoms (Schiffer et al., 2007)‏

Question 16

Depression and CHD

Answer 16

• Literature supports both an etiologic and prognostic role for depression in coronary heart disease Frasure-Smith and Lesperance (2006).
• Etiologic studies suggest relative risk of depression leading to onset of CHD is 1.64 to 1.90 times higher
• Prognostic studies conclude that CHD pts with depression have 2.0 to 2.5 times higher risk of mortality in first two years
• Explanations vary from physiological changes (e.g. platelet activity) to behavioural changes (e.g. levels of physical activity so less protective factors)
• depression more significant than previous MI and MI severity

Question 17

Coping with stress

Answer 17

Problem-focused coping

• planning
• exercising restraint
• can be unhelpful sometimes, e.g. not much to plan in a terminal disease

Emotion-focused coping

• acceptance
• denial
• repression
• wishful-thinking

Seeking social support

• help and guidance
• emotional support
• affirmation of worth
• tangible aid (e.g, money)

Question 18

Approach and Avoidance

Answer 18

• Approach = activity that is oriented toward a threat (e.g. problem-solving, planning a response)
• May want to discuss illness and treatment in detail
• Avoidance = activity that is oriented away from a threat (e.g., denial, distraction)
• May find it difficult to engage in discussions around illness and treatment
• Utility of coping style may depend on the situation

Question 19

Social Support

Answer 19

• A large meta-analysis has suggested that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships.
• Social relationships exert an independent effect beyond protective psychological role
• Effect comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity).
• 86 women with breast cancer were randomly assigned to a support group or control – i.e. normal medical care
  Aim was to improve quality of life
• BUT, 48 months later all the women in the control had died whereas a third of the women from the support group were still alive (Spiegel et al. 1989)‏

Question 20

Swearing as spin relief

Answer 20

• frequently witnessed in painful situations
• considered a maladaptive response was associated woth negative and unhelpful thoughts.
• people able to hold hand in ice water longer when sweaaring
• pain perception also changed with swearing

Question 21

Branding and treatment of headaches

Answer 21

• 4 groups, drug, placebo, branded and non-branded
• branding helps
• subjective labelling of how they are feeling better with branded drug and branded placebo both better

Question 22

Placebo Effect (“I will please”)

Answer 22

The phenomenon in which a placebo - an inactive substance like sugar, distilled water, or saline solution - can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful.

Question 23

Nocebo effect (‘’ I will harm”)

Answer 23

• A negative effect that occurs after receiving treatment (therapy, medication), even when the treatment is inert/sham
• Warnings about the possible side effects of a medicine makes it much more likely that the patient will report experiencing those effects
• One out of 20 placebo treated patients discontinued treatment due to ‘side effects’

Question 24

Placebo as treatment

Answer 24

• chronic medication is an increasing issue.
• e.g. opioid prescribing more then 2x the period 1998 to 2018
• double blind study for topical drug for psoriasis
• 3 groups: full dose, half dose (partial reinforcement), half does.

Question 25

Placebo without deception

Answer 25

• 80 pts diagnosed with IBS were randomly assigned to ‘open placebo’ or treatment as usual
• Pts informed treatment was “placebo pills, made of an inert substance, like sugar pills”
• Symptoms of IBS and QoL were measured as outcome
• open placebo was better than no treatment, improved QoL etc.

Question 26

Psychological mechanisms underlying placebo effect

Answer 26

• framing
• social learning
• experimental learning
• classical conditioning

Question 27

Classical conditioning to explain the placebo effects

Answer 27

Stimulus:
Response:
Conditioned Stimulus:
Conditioned response: