Exam 2 Flashcards
Moderator
A variable that changes the relationship between two other variables
Ex: Exercise is a moderator for stress
Coping
The process of trying to manage demands that are appraised as taxing or exceeding one’s resources
Active and changing process, affected by personality
Negative affectivity
A personality variable marked by a pervasive negative mood, including anxiety, depression, and hostility; believed to be implicated in the experience of symptoms, the seeking of medical treatment, and possibly illness.
AKA: Neuroticism
On a sliding scale
Associated with a wide variety of negative psychological outcomes including depression, anxiety, substance abuse
Has modest heritability
Optimism
Tendency to expect positive outcomes rather than negative outcomes
Psychological control
The perception that one has at one’s disposal a response that will reduce, minimize, eliminate, or offset the adverse effects of an unpleasant event, such as a medical procedure.
Conscientiousness
The propensity to follow socially-prescribed norms for impulse control, to be task- and goal-directed, to be planful, to delay gratification, and to follow norms and rules
Higher levels of conscientiousness were found to be significantly associated with higher physical activity and lower levels of excessive alcohol use, drug use, unhealthy eating, risky driving, risky sex, suicide, tobacco use and violence
4 major coping styles
Approach/Avoidant
Problem focused
Emotion focused
Rumination
Approach Coping Style
Aka confrontative, vigilant
The tendency to cope with stressful events by tackling them directly and attempting to develop solutions; may ultimately be an especially effective method of coping, although it may produce accompanying distress.
Avoidant Coping Style
Aka minimizing
The tendency to cope with threatening events by withdrawing, minimizing, or avoiding them; believed to be an effective short-term, though not an effective long-term, response to stress
Problem-focused coping
Attempts to do something constructive about the stressful situations that are harming, threatening, or challenging an individual.
Beneficial if something can be done about the problem
Emotion-focused coping
Efforts to regulate emotions associated with a stressful encounter; can be associated with distress.
Beneficial if nothing can be done about the problem
Rumination
Tendency to focus on the negative aspect of the stressor, or the negative emotions experienced as a result of the stressor, in a passive and repetitive way
Decidedly not beneficial to health
Holds one in an ongoing state of negative thoughts and emotions and does nothing to help an individual cope with or move past a stressor.
Co-rumination
Sharing negative thoughts and emotions with others who also foster and support those negative thoughts and emotions
Associated with increased symptoms of depression
SES and Coping
Those who perceive themselves as having higher SES cope more effectively and have better health outcomes
Several reasons for this; may have more resources than those with lower SES and have less daily stressors
Successful coping
Successfully addressing tasks in several domains:
1) reduce stressful environmental conditions
2) maximize the chance of recovery, if relevant
3) adjust to or tolerate negative events
4) maintain a positive self-image
5) maintain emotional equilibrium
6) continue satisfying relationships with others
Social support
Information from other people that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligation.
Types include: Esteem support, Informational support, Social companionship, Instrumental support
Positive effects on psychological functioning, health behaviors and illness, as well as the ability to cope successfully with stress.
Not measured by number of friends
Esteem support
Other people increase one’s self-esteem
Informational support
Other people are available to offer advice
Social companionship
Support through activities
Instrumental support
Physical help
2 main hypotheses on how social support influences health
Direct/Main Effect Hypothesis
Buffering Hypothesis
Direct/Main Effect Hypothesis
The theory that coping resources, such as social support, have direct beneficial psychological and health effects under conditions of both high stress and low stress
Absence of social support is itself a stressor that can lead to illness
Buffering Hypothesis
The hypothesis that coping resources are useful primarily under conditions of high stress and not necessarily under conditions of low stress.
Described using social comparison theory and role theory
Social comparison theory
Individuals are able to select appropriate coping strategies by comparing themselves to those around them
Role theory
As individuals experience differing stressors, they can change their roles to deal most appropriately with the stressor as friend, CEO, mother, wife and so on.
Having other people in one’s network allows one to select roles as appropriate to meet the demands of the stressor.
Coping interventions
Mindfulness
CBT
Exercise
Mindfulness
Involves the ability to be fully present in the current moment and to pay attention to the thoughts, emotions and sensations one is feeling at any given time.
Calls on individuals to be free of judgment and to accept things as they are in the moment.
Cognitive-Behavioral Therapy
Form of psychotherapy that addresses the thoughts and behaviors that lead to negative emotional states such as depression and anxiety.
Exercise
Can be helpful for individuals in terms of putting nervous energy to use, thereby helping to cope with anxiety
Can also be activating for individuals who are suffering from depression, thereby improving mood
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Cannot be measured objectively; is subjective
Includes physical and emotional components
Critical feedback system to keep us healthy and safe
Theories of pain
Specificity theory
Pattern theory
Gate-control theory (GCT)
Specificity theory
Individual nociceptors (pain receptors) deliver pain stimuli directly to specific corresponding areas of the brain via pain pathways known as A-delta fibers and C-fibers, thereby triggering the recognized experience of pain and subsequent pain behaviors. Greater the intensity of stimulus, greater the intensity of pain experienced
3 problems with specificity theory
- No evidence supporting notion of specific brain locations for pain
- Pain fibers do not only respond to pain, but to other sensations as well, including temp. and pressure
- Does not seem to be a 1:1 relationship between stimulus intensity and intensity of pain experience (differs across individuals and situations)
Pattern theory
Stimulation of nociceptors in body generate patterns of impulses that are transmitted to the dorsal horn of the spinal cord. If patterns exceed a given threshold, info about pain is then transmitted to brain and pain is perceived
Advantage: allows for stimulation of nociceptors without automatic experience of pain (i.e., sub-threshold stimulation) accounting for the lack of pain in the presence of some stimulation.
Problems with pattern theory
- Some people experience pain in absence of stimulation of nociceptors (phantom limb pain)
- Some people don’t experience pain immediately, but after the event
Gate-control theory (GCT)
Pain is a multidimensional perceptive experience that is subjective and includes physiological and psychological components
There is a gating mechanism in dorsal horn of spinal cord that inhibits or allows transmission of pain info to the brain. Dorsal horn receives info from nociceptors and brain about psychological state of individual
Info from both directions influences conscious experience of pain
Advantage: allowance for a role of psychological factors in the experience of pain.
Problems with GCT
- No direct evidence of gating mechanism in dorsal horn.
2. Not able to account for phantom limb pain
Relationship between mood and pain
Bidirectional
Anxiety, depression, and anger all positively associated with perceived intensity of pain
Anxiety
Typical consequence of pain
Adaptive response, but increased anxiety can perpetuate itself and increase likelihood of pain
Depression
Serotonin and norepinephrine involved in both depression and pain
Anger
Can increase muscle reactivity that can contribute to pain
Can overburden endogenous opioid system in brain, inhibiting the body’s natural ability to manage pain
Substance abuse
Linked with chronic pain, mood and anxiety disorders
Catastrophic thinking
Aka catastrophizing
Dysfunctional thought or cognitive error
Tendency to predict future negatively without consideration of other, more likely outcomes
3 main components: rumination, magnification, and helplessness
Linked to incidence of pain and transformation of acute to chronic pain
Associated with depression
Rumination
Going over and over the same idea or focusing exclusively on one idea, such as pain
Magnification
Tendency to overestimate the degree of threat or harm
Helplessness
Underestimation of personal and other resources available for coping
Perceived control
Refers to both cognitive and behavioral control
Low levels linked to higher disability levels related to chronic pain and depression
Cognitive control
Extent to which individuals can control their thoughts to cope with pain
Ex: through distraction
Behavioral control
Ability to alter behavior in a way that either eases painful stimuli or enhances coping
Ex: relaxing tense muscles to ease pain
Secondary gain
Benefits of being treated for illness, including the ability to rest, to be freed from unpleasant tasks, and to be taken care of by others.
Can be a motivator to engage in illness-related behaviors
Not necessarily a conscious, deliberate process
Conditioning
Process by which individuals learn to respond to cues or stimuli in their environments.
Can increase frequency or severity of pain behavior and possibly also perception of pain intensity
Analgesic drugs
Painkillers
Range from OTC like Tylenol to more intense narcotics like Vicodin
Opioid
Narcotics
Act on opioid receptors in brain- endogenous pain control system
High potential for abuse and addiction
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Ibuprofen, Naproxen, Meloxicam, Fenoprofen
Not addictive
Can be prescribed in conjunction with opioids
Muscle relaxants
Help control musculoskeletal pain
Valium, Flexeril
Antidepressants
Cymbalta
Have some efficacy in treating chronic pain
Epidural steroid injections
Sometimes used to reduce inflammation in an attempt to reduce pain
Transcutaneous electric nerve stimulation (TENS)
Electrical stimulation of nerve endings to reduce pain
Acceptance and commitment therapy (ACT)
Blend of cognitive behavioral therapy and mindfulness that seeks not to control or help individuals avoid pain, but to learn to cope with it and live a productive, rewarding life worth living with the pain
There is a difference between pain and suffering
Pain cannot always be avoided, but suffering is something an individual can choose to engage in or not
Pain behaviors
Behaviors that arise from chronic pain, such as distortions in posture or gait, facial and audible expressions of distress, and avoidance of activities
Pain-prone personality hypothesis
A constellation of personality traits that predispose a person to experience chronic pain
Ex: Neuroticism, introversion, and the use of passive coping strategies
Counterirritation
Inhibiting pain in one part of the body by stimulating or mildly irritating another area.
Biofeedback
Method of achieving control over a bodily process
Providing biophysiological feedback to a patient about some bodily process of which the patient is usually un- aware.
Health literacy
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Palliative care
Medical care designed to help patients feel more comfortable, rather than to cure disease
Involves not merely pain relief, but attending to the emotional and spiritual needs of the patient in addition to physical needs
Takes a team of people
6 aspects of a good death
- pain and symptom management
- clear decision-making
- preparation for death
- completion (spiritual)
- contributing to others
- affirmation of the whole person
Quality of life
The degree to which a person is able to maximize his or her physical, psychological, vocational, and social functioning; an important indicator of recovery from or adjustment to chronic illness.
Major depressive disorder (Depression)
A neurotic or psychotic mood disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide.
10–25 percent among women and 5–12 percent among men
Common and can range from mild to extremely debilitating.
Strong links between depression and cardiac illnesses, and between depression and chronic pain
Significantly positively associated with smoking and drinking problems, as well as reduced physical activity
Individuals with depression have more frequent and more intense reports of physical pain
Mood disorders
Depression
Bipolar disorder
Dysthymia
Bipolar disorder
Depressive episodes and manic or hypomanic episodes
Dysthymia
A milder, more chronic version of depression
Major Criteria for Depression
- Depressed mood most of the day, nearly every day
- Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss (when not dieting) or significant weight gain or decrease or increase in appetite
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation or a suicide attempt or plan
*Must experience at least 5 over a 2 week period
Anxiety disorders
Approximately 29 percent of people suffer from at least one anxiety disorder
Comorbid with other anxiety disorders, as well as with mood disorders.
Physical symptoms including tight chest, heart palpitations, physical restlessness and muscle tension
Associated with a variety of physical illnesses including cardiac disorders, hypertension, gastrointestinal problems, genitourinary disorders and migraine
Can exacerbate the experience of pain and chronic pain has been linked to anxiety disorders.
Association of anxiety with respiratory illnesses is significant
Cognitive behavioral therapy and relaxation therapy can be very helpful
Types of Anxiety Disorders
Agoraphobia Panic Disorder Specific Phobia Social Phobia OCD PTSD Generalized Anxiety Disorder
Agoraphobia
Anxiety about being in places/situations from which escape might be difficult/embarrassing should a panic attack happen
Panic Disorder
Presence of one or more panic attacks:
Discrete period of intense fear/discomfort with 4+ of the following that start abruptly and peak within ten minutes
Specific Phobia
Persistent fear that is excessive or unreasonable, cued by presence or anticipation of specific object or situation.
Subtypes: animal, natural environment (e.g,. storms), blood-injection, situational (e.g., bridges, tunnels)
Social Phobia
Persistent fear of 1+ social or performance situations where one is exposed to unfamiliar people or possible scrutiny
Exposure to the situation provokes anxiety
Recognition that the fear is excessive/unreasonable
Feared situations are avoided or endured w/ intense distress
OCD
Obsessions
Recurrent and persistent thoughts/impulses/images experienced as intrusive and inappropriate, causing anxiety
Attempts are made to ignore or suppress them
Recognition that these are a product of one’s own mind
Compulsions
Repetitive behaviors or mental acts that one feels driven to perform in response to an obsession according to rigid rules
Behaviors or mental acts aimed at preventing or reducing distress
PTSD
Exposure to a traumatic event involving actual or threatened death or injury and responded to w/ fear, helplessness or horror
Persistent re-experiencing of event (dreams, intrusive thoughts, flashbacks)
Persistent avoidance of reminders of the trauma and numbing of responsiveness
Persistent increased arousal (hypervigilance, increased startle response)
Generalized Anxiety Disorder
Excessive worry and anxiety more days than not for at least six months about a number of events or activities
Worry is difficult to control
Accompanied by 3+ physical symptoms (restlessness, fatigue, difficulty concentrating, irritability muscle tension, sleep disturbance)
Somatoform Disorders
Characterized by the presence of physical symptoms that have no known or identifiable physical/organic cause.
Physical symptoms are not intentionally produced or faked
Hypersensitivity combined with a tendency toward catastrophic thinking could provide one explanatory model for somatization symptoms
Types of Somatoform Disorders
Somatization Disorder Conversion Disorder Pain Disorder Hypochondriasis Body Dysmorphic Disorder
Somatization Disorder
Many physical complaints over several years:
4 pain symptoms (pain in four different sites/functions)
2 gastrointestinal symptoms
1 sexual symptom
1 pseudoneurological symptom
Symptoms are not due to a known medical condition or are in excess of what would be expected from a medical condition
Often results in feelings of rejection and distress at not being believed or being dismissed.
Conversion Disorder
One or more deficits in voluntary motor or sensory function
Psychological factors are associated with the symptom, preceded by conflict or stressor
Symptom cannot be explained by a medical condition
Pain Disorder
Pain in 1+ anatomical sites
Psychological factors are associated with the onset, severity, exacerbation or maintenance of the pain
Hypochondriasis
Preoccupation with having, or belief one has, a serious disease
Preoccupation persists despite medical evaluation and reassurance
Duration is at least 6 months
Body Dysmorphic Disorder
Preoccupation with an imagined defect in appearance
Cognitive Behavior Therapy
The use of principles from learning theory to modify the cognitions and behaviors associated with a behavior to be modified; cognitive-behavioral approaches are used to modify poor health habits, such as smoking, poor diet, and alcoholism.
Best for depression and anxiety
Identifying dysfunctional thoughts that cause or maintain the symptoms
Behaviors that may be exacerbating or continuing the symptoms are identified and replaced with more adaptive behaviors.
