Health Psychology

Question 1

1. What is appraisal of stress?
2. name the emotional responses to stress
3. name the cognitive responses to stress
4. name the behavioural responses to stress
5. name the physiological responses to stress
6. How can physiological symptoms exacerbate stress
7. in what type of people is this more likely to occur?

Answer 1

1. assessment of life events to determine whether we develop a stress response
   - primary appraisal - initial appraisal of life event
   - secondary appraisal - appraisal of coping abilities and external resources
2. feeling on edge, sad, irritable, tearful. Overreacting
3. difficulty concentrating, making decisions and switching off. Sensitive to criticism and Self critical
4. comfort eating/loss of appetite. Excessive drinking and or smoking. excess activity or underactivity. disturbed sleep
5. increased heart and resp rate. muscle tension. Increased perspiration.
6. physiological symptoms can be misinterpreted as symptoms of an illness, which therefore adds to stress/worry, leading to an exacerbated stress response (viscious cycle)
7. people with a tendency to worry, mental illness, or previous illness

Question 2

1. What are medically unexplained symptoms?
2. How are MUS produced?
3. How do MUS link to stress? (3)

Answer 2

1. physical symptoms that are not explained by organic disease, which cause distress and impair functioning, and for which there is positive evidence/strong assumption that they are related to psychological factors
2. produced by unconscious mechanisms
3. misinterpreted bodily sensations (such as physiological responses to stress)
   minor pathology that is exacerbated by stress
   poorly understood neurobiological mechanisms associated with changes in cortisol levels

Question 3

1. How does stress impact existing physical illness?
   a) indirect mechanisms
   b) direct mechanisms
2. Name 4 individual factors that may influence the coping response to stress
3. name 4 factors regarding the illness that may influence coping response
4. name the 5 dimensions of Leventhal’s illness cognitions.
5. Describe the problem solving coping strategy
6. describe the emotion focussed coupling coping strategy.

Answer 3

1. related to relapses, poor disease management or morbidity
   a) poor compliance with mediciation or poor management of conditions
   increased alcohol intake which can cause/exacerbate liver disease and epilepsy
   increased smoking
   reduced exercise
   poor diet
   b) increased cortisol and catecholamine secretion via HPA and SAM activation. These may have a negative effect on the body at the cellular level
2. premorbid personality; prior experience of illness; childhood difficulties; appraisal
3. immediacy; uncontrollability; ambiguity; undersirability
4. Identity - label and strategy
   timeline - perceived duration
   consequences - expected outcome
   cause - personal ideas about cause (links to locus of control)
   control/cure
   * these dimensions influence a patient’s response to their illness
5. controlling the problem and reconstructing it as managable by seeking info and support, learning new procedures and behaviours, identifying alternative rewards/activities and developing an action plan
6. managing emotions to maintain emotional equilibrium. talking about problem; making and maintaining supportive friendships; gaining emotional support from e.g. religion. Resigned acceptance

Question 4

1. what is pain?
2. what is chronic pain?
3. what type of symptom is non-specific lower back pain?
4. Name 6 yellow flags associated with a history of non-specific lower back pain

Answer 4

1. an unpleasant sensory and emotional experience associated with actual or potential tissue damage
2. long term pain (6 months +) that extends beyond the expected period of healing and frequently has no identifiable cause
3. medically unexplained symptom
4. • negative attitude that pain is harmful or potentially severely disabling
     - fear avoidance behaviour
     - reduced activity levels
     - expectation that passive rather than active treatment will be benficial
     - tendency to depression/low morale/social withdrawal
     - social or financial problems

Question 5

1. what is the pain gate theory?

2. what is the central sensitisation theory?

Answer 5

1. describes how the more we think about pain, the worse the pain feels. A series of spinal cord gates, into which pain messages arrive from the body can be open at times and closed at others. Certain circumstances, including stress and psychological factors can lead to these gates being open, leading to an enhanced experience of pain
2. hyperalgesia and allodynia. Lowered pain threshold comes to maintain pain.

Question 6

Describe the following approaches to chronic pain management

1. pharmacological
2. physical
3. psychological
4. behavioural

Answer 6

1. painkillers and tricyclic antidepressants
2. graded exercise, interventions such as TENS, accupuncture
3. CBT. Psychoeducation. Mindfulness
4. goal setting, relaxation. return to work

Question 7

1. How can psychological factors affect chronic pain? (2)
2. Describe the holistic model of Pain
3. What is appraisal?

Answer 7

1. psycholoigcal threats can increase sensitivity to potential physical threats
   pain can be a protective response to psychological stimuli
2. Pain can affect life in various ways: behaviour, physically, mood, environment and thoughts. These factors all interract with each other and influence the perception of pain
3. the meaning that individuals give to an event, that determines their response to it.

Question 8

1. What concept is CBT based on?
2. name the components examined in CBT?
3. How does CBT work?

Answer 8

1. that thoughts, feelings, physical sensations and actions are interconnected and that negative thoughts and feelings can trap you in a vicious cycle
2. thoughts, emotions, physical experiences and behaviour
3. break down problems into above components, to identify areas where people are getting stuck or that are unrealistic/unhelpful.
   change these unhelful thoughts and behaviours by challenging ideas, and developing more helpful thoughts and behaviours.

Question 9

1. what is stress?
2. what is eustress?
3. what is distress?
4. what is a stressor
5. give examples of the following stressors:
   a) external
   b) internal
   c) psychosocial events
   d) physioloigical events

Answer 9

1. any condition that actually or potentially poses a challenge to the body’s ability to maintain homeostasis
2. good stress. Mild stress that prepares use to meet challenges, is helpful and improves performance
3. bad stress. unpleasant or disease producing stress, that is harmful and impairs performance
4. a stimulus that produces a stress response
   5a) physical environment, social interractions, organisational, major life events, daily hassles
   5b) lifestyle choices, negative self talk, personality traits
   5c) unemployment, marriage/divorces, bereavement, new job/work problems, financial difficulties
   5d) blood loss, surgery, hypoglycemia

Question 10

Describe the following stages of the stress response:

1. alarm phase
2. resistance phase
3. exhaustion

Answer 10

1. short term stress response. initial fight or flight response. mediated by sympathetic nervous system and catecholamines
2. long term stress response. Body attempts to cope with prolonged stress. Mediated by HPA avtivation and cortisol release
3. Exhaustion phase - resources are depleted and body is unable to maintain function

Question 11

1. Describe the activation of the sympathetic nervous system as part of the short term stress response
2. describe the sympathetic responses in the short term stress response
3. describe the activation of the hypothalamic-pituitary axis
4. describe the effects of cortisol
5. Describe the effects of prolonged exposure to high levels of cortisol

Answer 11

1. cerebral cortex > hypothalamus > sympathetic nervous system activation > activation adrenal medulla > release of NA and adrenaline
2. increased HR and BP; blood diverted to heart and skeletal miscles and away from non essential organs; dilation of airways; glycogenolysis > increased metabolic rate
3. neurosecretory cells release corticotropin releasing hormone > activation of anterior pituitary > release of adrenocorticotropic hormone > stimulation of adrenal cortex > release of cortisol
4. lipids and amino acids released into blood; gluconeogenesis; aldosterone release - retention of sodium; immune suppression

5. muscle breakdown
immune suppression
ulceration of GI tract
depression/psychosis
failure of pancreatic beta cells
ageing

Question 12

1. what type of responses is the amygdala involved in?
2. what nucleus leads to the stress response when activated?
3. how do the amygdala and hippocampus regulate the HPA axis?
4. how is the amygdala implicated in emotional memory?

Answer 12

1. fear
2. activation of central nucleus in the amygdala
3. regulate CRH neurons
   amygdala activates the HPA axis
   hippocampus supresses the HPA axis
   cortisol binds to glucocorticoid receptors in the hippocampus, thus downregulating the HPA axis (negative feedback)
4. an emotional stimulus increases signal strength in the amygdala and hippocampus. Injecting cortisol enhances memory of emotional stimuli. Beta blockers and amygdala lesions reduces memory of emotional stimuli

Question 13

1. describe typical symptoms of anxiety
2. what is generalised anxiety disorder?
3. what is panic disorder?
4. what is OCD?
5. What is PTSD?
6. Describe 2 brain changes that occur in PTSD
7. Describe treatment approaches for anxiety disorders:
   a) psychosocial
   b) pharmacological

Answer 13

1. tension, over activitty of ANS, upset stomach, expectation of impending disaster, continuous vigilance for danger, insomnia
2. ongoing state of anxiety, lacking any reason or focus. Excessive worry about many issues
3. brief periods of intense terror and apprehension
4. intrusive thoughts (obsessions) cause anxiety. Compulsions are repetitive behaviours that neutralise anxiety
5. anxiety triggered by recall of past stressful experiences. 6. Hippocampus reduced in size and abnormal activation of amygdala

7a) CBT - first approach
7b) second approach but often used in conjunction with psychotherapy
Benzodiazepines - GABA receptor agonists
SSRIs
Beta blockers