First Test Flashcards
Risk factors
Characteristics or conditions that are associated with the development of disease or injury
Can be biological or behavioral
Behavioral Risks
Any behavior in which we engage that places us at greater risk for the development of disease or illness
e.g., smoking, excessive etoh use, lack of exercise, obesity
Risk Factors (2)
Positive correlation between health and # of healthful behaviors (at all ages)
Negative correlation between health behaviors and death (particularly in older age)
So, why don’t people do what is good for them??
Personality
a person’s cognitive, affective, or behavioral tendencies that are fairly stable across time
The Biomedical Model
Plato—Mind and body are separate entities
View adopted in 19th century & dominant in medicine today
All diseases can be explained by disturbances in physiological processes (injury, biochemical imbalances, infection)
Disease affects the body
NOT psychological and social processes
Does not account for individual differences in each person
Psychosomatic medicine (1930s)
Founded by physicians
Mind & body are both involved in illness
Originally psychoanalytically influenced
Now focus is on interrelationships among physical, psychological, and social influences on illness
Health Psychology Goals
Goals
To promote & maintain health
To prevent & treat illness
To identify the causes and correlates of health & illness
To analyze and improve health care systems & health policy
Engel’s Arguments
The biomedical approach is reductionist , reducing patients to a sum of physical and medically validated symptoms
“Reductionism is particularly harmful when it neglects the impact of nonbiological circumstances on biological processes” (Holman, 1976)
Variability in clinical expression of a disease, as well as personal experience with a disease, is not fully accounted for by medical markers of the disease
E.g., We can’t tell how diabetes is affecting day to day life just by looking at blood glucose level
Patients can communicate important information about their illness and treatment experience that cannot be gained from medical tests alone.
E.g., Knowing that a patient has a high blood glucose level won’t tell us anything about their ability to reliability take their insulin!
Medical treatment does not always alleviate symptoms, even in the face of biological improvement
Example: The patient who no longer shows objective signs of injury to the knee, but still reports high levels of pain at the injury site.
Physicians who can instill peace of mind into their patients will have patients who:
Are more likely to follow treatment recommendations
Show greater signs of improvement
The Biopsychosocial Perspective
Holistic approach to health that expands the biomedical model by including biological, psychological, and social factors as important influences on health
Takes the whole person into account
All factors affect and are affected by a person’s health
Transaction
A continuous interaction between the person and his/her environment
Emotions, cognitions, & behaviors influence the stress experience
Stress
When the demands of a situation are perceived as greater than available resources to manage the situation (Lazarus & Folkman, 1984)
Resources include an evaluation of biological, psychological, & social systems
Biological Aspects of Stress
Reactivity
Change from baseline in our body’s physiological state when we encounter a stressful stimulus
Increased heart rate, respiration, etc.
Governed by the sympathetic nervous system (SNS) and endocrine system
Sympathetic Nervous System (SNS)
Responsible for arousal of the body and mobilization of energy in stressful situations
Parasympathetic Nervous System (PNS)
Responsible for calming the body
Works together with the SNS to maintain equilibrium in the nervous system
During stress
CRF/CRH (corticotropin releasing hormone): Produced in the hypothalamus and secreted by the paraventricular nucleus (PVN)
Sent to pituitary gland to stimulate release of adrenocorticotropic hormone (ACTH)
Suppresses appetite, increases anxiety, improves selective attention
Pituitary Gland
Master gland”
Receives chemical messages from hypothalamus & controls secretion of all other endocrine glands
ACTH
Follows diurnal rhythm—higher levels in the a.m., declining through the day
Released during times of stress to stimulate cortisol release by the adrenal glands
Adrenal Glands
Located on top of kidneys
Cortisol (corticosteroid)
Helps reduce swelling that results from injury (physiological stress)
Epinephrine & norepinephrine (catecholamines)
Responsible for bodily reactions that prepare the body to confront stress
Increased heart/respiration rate, increased sugar production for quick energy
General Adaptation Syndrome (Selye)
Body’s response to prolonged stress
Fight or flight
Immediately helpful, but damaging if prolonged
Fight or flight is only the initial response
Allostatic Load
Accumulated effects of physiological strain due to stress on the body over
Includes hormone, immune system, cardiovascular changes
Negative correlation with health status in children and elderly (Johnston-Brooks et al., 1999)
Allostatic Load Influencing Factors
Amount of exposure—frequency, intensity, and duration matters
Magnitude of reactivity—individual differences in physiological responses to stress
Rate of recovery—ruminating or worrying prolongs reactivity
Resource restoration—sleep is a major part of restorative process
Accumulated Effects Over Time
Severe and ongoing childhood stress can change the body’s reactivity over time
Greater stress response (Gilbert et al., 2015)
Slower recovery (McCrory et al., 2015)
Greater risk of illness in adulthood (Miller, Chen, & Parker, 2011)
Higher levels of allostatic load in adulthood (Gruenwald & colleagues, 2012)
Evidence of faster aging processes (Kiecolt-Glaser et al., 2011)
Cognitive Appraisal (Lazarus, 1999; Lazarus & Folkman, 1984)
Accounts for individual differences in response to a stressor
Primary appraisal
Evaluation of the significance of the stressor
Is it stressful, challenging, controllable, positive, etc.?
What is the expectation for future harm?
“How will this affect me?”
Harm-loss
How much damage has already occurred?
Threat
What additional damage is likely to occur?
Challenge
What is the opportunity for achievement or gain?
Transactional Relationships Between Stress & Psychosocial Factors
Stress & cognition
Memory, attention, concentration
Thoughts can produce stress, too
Stress & emotion
Emotions often are used to evaluate stress
Reaction depends on appraisal
Fear, anxiety, depression, anger
Stress & social behavior
Nature of stressor can determine changes in prosocial behavior
Aggressive behavior often increases (Child abuse)
Some Sex Differences in Stress
Women:
Report experiencing more stressors than men
Greater strain working outside home & managing household responsibilities
Men
Higher levels of stress reactivity
May be situation-specific (e.g., when competence is challenged)
Slower rates of recovery
Measuring Stress
Physiological measurements
Assessing the body’s level of physiological arousal during stress
Blood pressure, heart rate, respiration, galvanic skin response (Polygraph measures all of these!)
Assess changes in hormone levels through blood, urine, or saliva analysis
Advantages: Objective, quantifiable, and reliable
Disadvantages: Affected by gender, weight, caffeine intake; may create arousal; expensive
Measuring Stress (2)
Life Events
Social Readjustment Rating Scale (Holmes & Rahe, 1967)
Self-report of major happenings in life that require some degree of psychological adjustment
Strengths & weaknesses?
Measuring Stress (3)
Daily Hassles
Smaller, day-to-day unpleasant occurrences
Hassles Scale (Kanner et al., 1981)
Assess hassles experienced and their severity
E.g., losing something, stuck in traffic
More strongly correlated with health than life events
Social Support
Comfort, care, & assistance available from others
Everyone’s need is different, and may change depending on circumstances
Includes received support & perceived support
Tends to decline in chronic stress situations
Types of Social Support
Emotional (esteem) support
Common type of support—encouragement, empathy, concern
Buffers the negative emotional impact of stress
Instrumental support—giving direct assistance
Meals, money, help with household chores
Informational—advice, feedback
Companionship—spending time together, providing a sense of belonging
Does Social Support Reduce Stress?
Greater levels of social support predict:
Lower levels of job stress (Cottington & House, 1987)
Lower blood pressure on the job (Karlin et al., 2003)
Larger nighttime declines in blood pressure (suggesting better restorative sleep; Troxel et al., 2010)
Less physiological reactivity while giving a speech (Uchino & Garvey, 1997)
Buffering hypothesis (Cohen & Wills, 1985)
Social support protects people from the negative effects of high stress
We appraise and respond to stress in a healthier manner w/better support
Statistically, stress and SS interact
E.g., During periods of high work stress (but not low stress), support is negatively correlated with blood pressure (Karlin, Brondolo, & Schwartz, 2003
Direct effects hypothesis (Cohen & Wills, 1985)
Also called main effects hypothesis
Social support has a positive impact on health regardless of severity of stress, likely because social support is related to other positive outcomes that affect stress
May have good sense of self-esteem and belonging
May lead people to adopt healthier lifestyles
Also supported by research data
Stress Prevention Model
Uchino & Birmingham, 2011
Social support provides resources to individuals that help to avoid or minimize exposure to stressors
E.g., Learning to make good choices, interacting with others in constructive ways to minimize conflict
Personal Control
Belief that one can make decisions and take actions to produce desirable outcomes & avoid undesirable ones
Behavioral control—Ability to take action
Cognitive control—Ability to think differently or in a more positive way
Modifies relationship between stress & health
Significant individual differences
Related to lower perceived stress
Locus of Control
Attribution of control over one’s successes and failures
Internal: We believe we have control over our success & failure
External: We believe our success & failure is largely due to external factors or chance
Includes self-efficacy (Bandura, 1986)
Our beliefs about our ability to accomplish something
Prior successes in an area reinforce future attempts
Learned Helplessness (Seligman, 1975)
Attributions about bad events can be
Internal vs. external—Is the cause due personal inability or environmental factors?
Stable vs. unstable—Is the cause long-lasting or temporary?
Global vs. specific—Does it affect many areas or just this one?
Rodin & Langer, 1976
Experimental study on the effects of responsibility on personal control and health in a nursing home population
Tx Group: Choices re: having/caring for a plant, selecting daily activities, moving furniture
Control Group: No choices or responsibilities
Results:
Tx group participants were happier, more active at the end of study and 1.5 years later
Tx group participants were healthier and 50% less likely to die before follow-up
Type A and Health
Greater stress reactivity & perception of threat (Glass, 1977)
Type A is positively correlated with:
Mortality
Risk for coronary heart disease (CHD)
Angina, atherosclerosis, myocardial infarct (MI; Rosenman et al., 1986)
White collar jobs
Magnitude of correlation often depends on how Type A is measured
