health psychology

coping with chronic condition

being future oriented and setting goals flexible coping styles: assimilation- persistently pursues goals that may not be realistic accomodation: flexible, modifies goals so that she/he is working towards something attainable

pain treatments 2

biofeedback: a method of achieving control over a bodily process. sensors provide feedback about physiology. learn to manipulate physiology through changes of behavior ex: BP is identified then converted into a tone and can learn what behaviors or thoughts will modify the bodily function. muscle relaxation, bring blood to part of the body- chronic pain syndrome, effective headaches and facial pain hypnosis: work if you think it work, state of relaxation reduces stress and discomfort. - one of the oldest pain management -combines relaxation, suggestibility and distraction, focus attention, alter subjective experience of pain. imagine a freely moving joints with no pain. transform pain into diff sensations. effective in pain management both acute and chronic pain

young adults (20-39) illness

can affect family of origin (parents. siblings), family of commitment (spouse, children) and close social network (extended family) affects career development and building an intimate relationship

different cancers

carcinomas(80%): breast, prostate, skin, lung sarcomas: strike muscles, bones lymphomas: lymph system leukemia: cancer of the body

pain

combination of emotional and physiological discomfort is associated with actual/potential tissue damage is a subjective experience

stress and immune function

common place stressor can adversely affect the immune system nonhuman research: loud noises, electric shock, separation from mother human research: marriage and hostility study with blister healing (took longer to heal) diff stressors create diff demands on the body and immune system acute stress: flight or fight increases natural immunity (prepare wound healing) chronic stress: failure at every level of immunity we know leads to all diseases associated with metabolic disorder (chd, diabetes)

DTCA

direct to consumer advertising of drugs pros: destigmatizes, acceptance, education cons: self-diagnosing, bias medicine

treatment for heart disease

dont delay seeking care after heart attack. -coronary artery bypass graft surgery -medication: beta blockers- reduce the effects of sympathetic nervous system, aspirin, statins -dietary change and increase in physical activity -stress management- stress management programs recognize stress, how to avoid it, and what to do when it is unavoidable. -depression treatment: CBT -social support: lack of social support during recovery predicts depression. -cardiac rehabilitation: produce a relief from their symptoms, reduce the severity of the disease, limit the progression, and promote social adjustments

causes of cancer

environmental factors (sun) a combination of environmental and genetic factors- causes damage to genes resulting in abnormal cell behavior infectious agents (virus causing agents) genetic predisposition behavioral, psychological: diet, lifestyle not related- stress alone

mutual participation relationship

equal partnership: open communication, shared responsibility the more active you are- the better the health benefits

open gate

facilitated by anxiety, depression, attention/distraction decrease pain experiencing closes gate

depression and adherence

found that depressed medical patients are three times more likely to be nonadherent. depression-> pessimism-> withdraw from social support

theories of pain

gate control- biopsychosocial model neurochemical basis of pain

active listening

giving complete attention to the participant

rehabilitation for stroke

medication, psychotherapy, including treatment for depression, cognitive remedial training to restore intellectual functioning, movement therapies. stem cell transplant also shows promise as a treatment constraint-induced movement therapy, which is targeted to upper extremities is effective. cognitive interventions make patients aware that they have problems. neurorehabilitation relies on the brain's ability to rebuild itself and learn new task. the idea is to rewire the brain so that areas of the brain other than one affected by stroke can come to take these functions.

women feel more pain than men where

migraines, headaches, pelvic pain, facial pain, lower back pain increase of neuroticism in women poor understanding of sex diff in tolerance/ threshold

guidance-cooperation relationship

more equitable relationship but physician makes decision

depression and immunity

negative affect is related to immune functioning (positive affect increases healing) depression is a culprit in the stress-immune relationship -delayed wound healing and increase of inflammation

nociceptors

nerve endings respond to pain contribute to it rather than create it involves: 1. mechanical (pressure) 2. thermal (heat/cold) 3. chemical (secreted damage tissues) all stimulate nerve endings signal that something is wrong, possible experience pain without nociception (phantom limb)

measurement of adherence

no gold standard self report, report of spouse, medical charts, pharmacy refill records, pill counts, urine/blood test, electronic measure

pain characteristics

quality: dull vs sharp or constant vs throbbing intensity: how much threshold: the point at which a stimulus is perceived as painful- physiologically determined tolerance: point cant stand it anymore- influenced by attitudes/motivations

decoding

recognition and understanding another persons nonverbal communication

pain treatment 4

relaxation: an individual shirts his or her body into a state of low arousal by progressively relaxing different parts of the body. controlled breathing- reduce pain sensitivity and can produce analgesic effects. can control some acute pains and chronic pain with other methods of control distraction: focusing attention on an irrelevant and attention-getting stimulus. useful especially with acute pain! patients that received music reported less discomfort, low level pain

ischemia

restricted blood flow to the heart (least damaging)

aging illness

stereotypes: lonely and uncared for older adults can be productive and independent: -working, -volunteering, -going back to school, -fulfilling family obligations, -recreation -negative labels by younger people -loss of their own health and possible and those families and spouse -family members can help - independent and control is crucial even in nursing home plant study

physician information gathering

symptoms, whats modulating them, what is is doing to themselves, patient telling history- symptoms are affecting their life physicians should ask open ended questions oppose to close ended. physicians interrupt approximately 20 seconds after participants begin speaking.

meta analysis improve adherence

tangible, emotional, cohabiting, close and cohesive family feel connected provider-patient open communication talk underlying beliefs make regime simple screen for depression determine available social support

neurochemical basis of pain

the brain controls the amount of pain an individual feels by transmitting messages down the spinal cord to block the transmission of pain

active-passive relationship

the patient has little control and is unable to participate in the care decision. (not great health outcome)

nociception

perception of pain physiologically

individual diff pain experience

personality: neuroticism is associated increase perception of pain and communication of pain age- people get older progressively increase reports of pain, decreases tolerance of pain socioculture factors: group differs gender: women report more frequent episodes of pain than men

treatments that relieve physical pain

treatments that relieve physical pain been shown to relieve emotional pain caused by social rejection. group- write about self reported hurt feelings acetaminophen treatment reported less susceptible to hurt feelings

patient's adherence/compliance

degree to follow recommendations of health care profession "stick to" patient compliance- the same but it has a negative connotation

pain behavior

distortion in posture or gait facial expressions irritability avoidance of activity sounds of pain

lessens pain

distractions- can lessen perception of pain sense of self control- ability to control aspects of pain can improve coping expectations- patients expectations can affect pain and healing

nonadherent

-failure to adopt the behaviors and treatments -failure to keep scheduled appointments -failure to take full dosage -failure to take medicine at correct intervals -ignore, forget, or misunderstand regime

low adherence and knowledge

patient dont understand the provider 50% of patients can remember what they were told in their last medical visit patients belief about cause of illness and how to treat it regimen complexity- more unlikely to adhere to it

cancer progression and psychosocial factor

-depression altered stress response -stress NK cells interventions critical- cancer symptoms and immune responses worsen

intervention to reduce risk factors

-dietary change -quit smoking -increase physical activity -reduce sitting -relaxation training to reduce hostility

risks of CHD

-inflammation process -high blood pressure -smoking -diabetes -obesity -low levels of physical activity -high cholestrol

coping and immunity

-optimism active coping strategies are protective against stress -benefit findings (silver lining) finding benefit in stressful events may increase immune functioning -other coping styles (relaxation, exercise) may be related to stress-immune functioning relationship

consequences of nonadherence

-over- prescription of medication -development of drug resistant infections -lack of improvement of symptoms -cost to health care system- multiple visits -no trust between physician and patients

statistics of pain

80% of medical visits involve some sort of pain 70-85% back pain daily arthritis (40 million) chronic headache (45 million)

hypertension- high blood pressure statistics

90% is essential (unknown) 5% caused by kidney failure genetic factor emotional factor family envionment stress-chronic social conflict, job strain combination of high demand low control extensive responsibilities in women migrating from rural to urban areas

psychoneuroimmunology

=behavioral, neuroendocrine, and immunological process of adaptation

key to behavioral change and adherence

1. information- know what to do 2. motivation- want to do it 3. strategy- be able to do it

verbal communication

1. instrumental/task orientated: biomedical talk, primarily verbal, transfer of information. 2. affective/socioemotional: includes nonverbal, communication of feeling, discussion of the patients psychosocial concern

5 parts to medical visit

1. opening: solicitation of patient's reason for visits- presenting the problem 2. history taking 3. physical exams 4. diagnoses 5. recommendations for treatment

metastasis

spread cancer cells other parts of the body

child coping chronic illness

25% of children have chronic condition (asthma, obesity) diff experience from adults infancy: can affect attachment and trusting relationship varying experience and response to illness depends on family, culture, social environment, age (depressed mothers) peer relationships: influenced and are influenced by illness -peers can reject -ill children deal with children by keeping secrets, hiding visible diff -having a close friend lessens the impact of the illness -summer camps increases opportunity to grow socially, increase self esteem sibling relationship: -sibling may feel resentful -more expected non ill siblings -confusion and anxiety -fear of loss -many sibling are resilient, mature, and happy

role of stress on heart disease

Biological reactivity to stress contributes to the development of CHD- plaque deposit increasing inflammation and leading to the development of lesions. also, prolonged recovery periods. Acute stress involving emotional pressure, anger, extreme excitement, negative emotions and sudden bursts of activity can precipitate sudden clinical events such as a heart attack. chronic and acute are related to heart disease CHD more common in individuals, especially men with low SES. the greater the chronic stress that people experience, the lower they are on the SES ladders. -job factors: strain -balanced of demand and control (inequality) -social instability (migrants higher chance of CHD) -control/demand in daily life.

coronary heart disease (CHD)

CAD may restrict blood supply to myocardium causing coronary heart disease is a disease of modernization, due at least in part changes in diet and reduced activity levels.

psychosocial interventions in cancer

CBT mindfulness-based on stress reduction -exercise -behavioral interventions for pain -expressive writing -family therapy -support groups

heart attack in women

43% said had no chest pain shortness of breath, general weakness, FATIGUE, COLD SWEATS, dizziness, nausea, sense of squeezing pressure increases significantly after menopause

measure pain

EMG electrical activity of muscle EEG electrical charges of the brain autonomic- blood pressure, galvanic skin response behavioral- observation of pain self-report verbal written description of pain from patient

coronary artery disease (CAD)

The buildup of plaque in the coronary arteries

heart attack in men

-chest pain or discomfort like pressure, fullness, squeezing or pain in the chest -squeezing or pain in the chest -discomfort or pain in other areas- arms, neck, jaw, back of stomach -shortness of breath, lightheaded, nausea -abdominal discomfort may feel like indigestion

psychological risk factors of CHD

-chronic stress -anger and hostility: increase risk for metabolic syndrome. acts as a potential trigger for heart attack with low survival rates. A geneticbased predisposition to physiological reactivity. Family environment that are non supportive, unaccepting, and filled with conflict promote the development of hostility. expressing hostile emotions, is more reliably tied to higher cardiovascular activity than is the state of anger and hostility. when a hostile person is provoked in interpersonal situations he/she shows exaggerated cardiovascular reactivity. -depression: appears to be environmental. depressions is linked to risk factors of coronary heart disease, metabolic syndrome, inflammation... treatment for depression (serotonin) reduced inflammation all of these had elevated levels of C protein marker of inflammation

provider and patient communication

-different levels in communication -different beliefs about how involved the patient should be communication can be taught and improved for both provider and patient. informed collaborative choice: physicians ask how involved the patients want to be- patients decide to participate in decision- greater confidence in health care decision. increases adherence, increase health, increase patients satisfaction

death in infancy or childhood

6.7 death per 1000 births, AA and Hispanic infants are still twice as likely to die during the first years as white infants are. countries that have lower rates: national medical programs, provide fee or low cost maternal care racial disparities in infant mortality rates exist in the us due to inequalities in access to healthcare- lack of prenatal care.

Physicians

are the main providers of healthcare. Advanced practice nurses nurse practitioners- do some initial treatments (if they are high frequency visits cold/flu), cancer screenings (routine care) PA (physician assistant): advanced training assistant

common sense model of illness

argues that people hold implicit commonsense beliefs about their symptoms and illnessses that result in organized illness representations or schemas. These are acquired through media, personal experience, from family and friends who have had experience with similar disorders.

encoding

ability to control one's emotions via nonverbal cues -physicians increase encoding abilities increases patient satisfaction

PREPARED

active paticipation: P- procedure (prescription) R- reason E- expectations P- probability solve problem A- alternatives R- risks (dependency?) E- expenses D- decision

types of pains

actue: pain lasting less than 6 months: wound/injury, cause anxiety, distress when have it (a delta fibers) chronic: last a long time (c fibers) benign: typically persists for 6 months or longer and is relatively unresponsive to treatment. ex: chronic low back pain recurrent: intermittent episodes that are acute in character but chronic inasmuch as the condition recurs for more than 6 months ex: migraine progressive: increase severity of pain over time. typically associated with malignancies or degenerative disorders such as cancer or rheumatoid arthritis

pain treatments 3

acupuncture: -ancient chinese techniques -fine needles inserted under the skin -can stimulate nerves associated with painful parts of the body -work as placebo, distraction, endorphin release - may be more effective with acute pain management physical therapy: -includes exercise, massage, use of heat/cold sensory control of pain -counterirritation: involves inhibiting pain in one part of the body by stimulating or mildly irritating another.

adolescents chronic illness

adherence is a challenge (rebellion/independence), personal expression of unique self, forming close peer relationships, moving away parental control

depression

affects coping, emotional, effects of pain 69% prevalence of pain in depressed primarily care patients depression and pain combined lead to greater impairment in social, work, functional aspects

effects of pain

affects healthcare spending, lose productivity, people fear pain, interactable pain: pain that cannot be relieved

cancer

all cancers result from a dysfunction in DNA- that part of the cellular programming that controls cell growth and reproduction which causes rapid cell growth and proliferation. a set of diseases in which abnormal body cells multiple spreading a tumor. 2nd leading cause of death behind heart disease.

phantom limb

amputations still feel pain. 65- 85% amputees: feel a cramping, shooting, burning, crushing pain remains a mystery. proof of psychological factors

issues effect adherence and nonadherence

good communication: adherence is highest when patient receives a clear, jargon free explanation of the etiology, diagnosis and treatment recommendation. if they ask to repeat the instructions, write down the instructions. -treatment regimen: treatment regimes that must be followed over a long time, that are complex, that require frequent dosage and that interfere with other desirable activities low levels of adherence. higher in cohesive families than families that are in conflict. depressed show low adherence to to treatment medication. Low IQ is tied to low adherence. also cite lack of time, no money, or distracting problems at home such as instability and conflict as impediments to adherence.

myocardial infarction

heart attack- type of CHD death of heart tissue due to interruption of blood supply

heart disease

heart disease: women suffer more than men atherosclerosis: heart arteries thickening due to plaque, reducing circulation to heart coronary a

normalizing

hiding symptoms and treatments to appear like everyone else helps counteract identity spread a person's limitations are over-generalized and spreads to unrelated areas. ex: speaking to blind louder

immune disorders

immune system- the surveillance system of the body natural: defense against a variety of pathogens specific: lymphocytes have receptor sites on their cell surfaces that fit only one antigen and respond to only one kind of invader

medication reminders

improve adherence postcard about follow visits daily calenders- linking medication taking with other routines reminder notes charts for dosing schedules timers

chronic illness

increases slowly over time. multiple causes- lifestyle/behavioral factors can be managed no cured as many as 1 in 2 americans have a chronic condition

closed gate

inhibited by activity in the a beta fibers, relaxation, distraction, positive emotion

stroke

involves restricted blood flow to the brain. restriction of blood supply or oxygen to the brain- death of neurons and loss of function hemoriagical stroke- bursting of vessels the llikelihood of stroke increases with age, occurs more often in men than in women, and occurs more often in african american and among those who have diabetes. (the group highest at risk for stroke black men age 45-64) - loss of cognitive abilities - loss functioning on one side of the body - emotional problems (anxiety) risk factors: similar to those for heart disease rehabilitation, psychotherapy, physical movement therapy, speech therapy

communication

is a bidirectional model exchange of information, verbal communication and nonverbal communication- eye contact, gestures, body language, touch, posture

social isolation and illness

is a problen. -anger, frustration, irritable can contribute to driving away those who care most

delay

is defined as the time between when a person recognizes a symptom and when the person obtains the treatment. appraisal delay- which is the time it takes an individual to decide symptom is serious illness delay- which is the time between the recognition that a symptom implies and illness and the decision to seek treatment behavioral delay- which is the time between deciding to seek treatment and actually doing so medical delay- scheduling and treating

women and CHD

is the leading killer of women in the US and most other developing countries. typically occurs later. Women have 50% chance of dying from first heart attack. may be protected against early onset coronary disease related to estrogen, and risks go up substantially after menopause. They have same risk factors as men. Men score higher on agency: which is focus on oneself- associated with good and mental health outcomes. Communion, a focus on others typically higher in women/ self sacrificing is tied to poor health

are nonverbal cues important?

look to nonverbal cues for support/ information. Patients express anxiety, depression, confusion. touch: convey comfort, indication of power eye contact: intensifies emotion, can be too much/too little body language: body orientation, interaction distance tone of voice- variation in pitch, volume, emphasis show recording of voice- more dominant the tone more likely to be sued (powerful cue)

anxiety and distress

magnifies pain, interferes with relaxation

gate control theory

nociceptors transmit impulses that flow from the PNS to the CNS through the dorsal horn- to brain a delta fibers: carry sharp pain, they respond especially to mechanical or thermal pain. c fibers: are unmyelinated nerve fibers involved in polymodal pain, slowly transmit dull aching pain a beta fibers: not related to pain (stops/distraction of pain) not all pain signals are carried by the nerve fibers emotions/cognition influences the gate

death between age 1-15

number 1 cause of death is accidents (40%)- in early childhood most frequent due to poisoning, injuries, or falls in the home. later years automobile bikes take over. number 2 death is cancer related (leukemia)- strikes the bone marrow producing excessive number of white blood cells.

delay behavior

occurs when an individual should seek treatment for a symptom but puts off doing so. ex: a factor contibuting to the high rate of death and disability from heart attacks is that patients often delay seeking treatments.

endogenous opiods

opiate-like substances produce within the body that regulates pain endorphines= endogenous morphine

patients adherence representation graph

patient resources: social support, mental health, beliefs and attitudes healthcare provider trust: effectiveness of communication, involvement of patient in decision making, teambased medicine- greater communication between diff fields simplicity vs complexity healthcare insurance: access to care, medical cost

social support

perception or experience that one is loved Informational, instrumental, emotional, invisible...

pain treatments

pharmacological methods: - nonsteroidal anti-inflammatory drugs (NSAIDS) ex: advil, asprin -narcotics: morphine, codine -tranquilizers/ sedatives: Valium -antidepressant -local anesthetics: can affect the transmission of pain impulses surgery most dramatic and short lived benefits, cutting or creating lesions in the pain fibers at various points in the body so that pain sensations can no longer be conducted. CBT: can be successful in managing chronic pain -multidisciplinary pain-management program with cognitive, physical, and emotion interventions -reduce negative thinking and external locus of control -identify situations likely to give rise to pain -effective in managing back pain guided imagery: conjured up an image to focus on most effective combined with other techniques ex: lake meditation

placebos and pains

placebo response is a complex, psychologically mediated chain of events that often have placebos may work work via some of the same biological pathways as real treatments. study revealed decrease activity in pain sensitive areas. physiological effects. placebos can stimulate the release of endogenous opiods, the body's natural pain killers In study, morphines/placebos worked for 35% of people people who have a high need for approval or low self-esteem and are persuadable in other contexts show stronger placebo effects.

middle age (40-65) illness

possible loss financial support, role reversal, feeling of burden to family, change in relationship with spouse/children

Diabetes

type 1: pancreas does not produce insulin develops in childhood (5-10%) type 2: does not produce enough insulin behavioral risk factors complications: blindness, foot soreness/amputations, skin complication, neuropathy, kidney disease, shorter life expectancy, increase heart disease challenges of diabetes: self management, type 1: checking blood glucose levels, insulin injections, dietary control, exercise type 2: reducing sugars, exercise, checking glucose levels, medication

angina pectoris

type of CHD just chest pain and difficulty breathing

rates of nonadherence

up to 70% are non adherent with lifestyle regimes. highest rates of adherence: HIV, cancer, arthritis regimes motivated, related to great expectation lowest rates of adherence: end stage of renal disease, diabetes, sleep disorder complex, unpleasant treatments

SIDS

usually 6 months or younger. Simply stops breathing- but epidemiological studies reveal that is it more likely to occur in low class urban environments, mother smoked during pregnancy, baby put to sleep on side or stomach. enormous psychological toll for parents- confusion, self-blame and suspicion sleeping position has been reliable related to sids (back sleep), blankets out of cribs, ceiling fan circulates air

other psychosocial risk factors of CHD

vigilant coping- chronically searching the environment for potential threats/- has been associated with risk factors for heart disease. vital exhaustion- a mental state characterized by extreme fatigue, feelings of being dejected or defeated, and enhanced irritability to cardiovascular disease. a bodily expression of depression social isolation- increases CHD