Health Psychology Exam 1

• Attempt to uncover what factors lead to stress • Mostly focused on measurement

Stimulus Approaches

• Acceptance and commitment therapy (ACT) - Teaches individuals to: • Accept the problem • Be aware of its occurrence and conditions that cause it • Change behaviors

Acceptance therapy

• Immigrant groups cope differently than other groups based on • Ethnic Identity • Acculturation • Changings resulting from contact with culturally dissimilar people, groups, and influences

Acculturative Stress

• Social support has positive effects on the cardiovascular, endocrine, and immune systems • Lowers physiological and neuroendocrine responses to stress • Decreases cortisol responses to stress • Better immune functioning • Modifies brain's responses to stress

Biopsychosocial pathways

Identify pessimists early so they can learn optimism • Taught to make external, temporary, and specific attributions • Healthier beliefs will promote positive outcomes

Changing Explanatory style?

As societies evolve, health belief systems develop as bodies of knowledge are constructed and exchanged among those who undergo specialized training This give rise to the separation of expert or technical beliefs systems from traditional, folk or indigenous systems

Chapter 2: Health belief systems

An interdisciplinary subspecialty of psychology dedicated to promoting and maintaining health and preventing and treating illness

Chapter1: Health Psychology

• Third leading form of cancer for both men and women • Result from small clumps of cells called polyps that turn cancerous • Several types of screening • Colonoscopies every 10 yrs starting at 50 (earlier if family history)

Colon Cancer Facts

Correlational research: measures whether a chance in one variable corresponds with changes in another variable Disadvantage: difficult to determine direction of causality unambiguously Advantage: more adaptable

Correlational Studies

Culture as the dynamic, stable, set of goals, beliefs and attitudes shared by a group of people Culture influences: Susceptibility to illness Acceptability of behaviors Access to services What health and wellness means

Cultural Emphasis

• A third of Americans use some form of CAM • CAM is used primarily for back problems, anxiety, depression and headaches • Most people who use CAM use it as complementary to traditional medicine, rather than as their only source (alternative); believe that the combination will produce faster results • Pain is the most common problem for people who report use of CAM • More hospitals offering CAM services every year

How widespread is CAM?

• Protects humans from bacteria and germs. • Key Elements • Lymphatic system: Network of capillaries that carry lymph and white blood cells • Leukocytes: White blood cells • Lymphocytes: Include T and B cells, and natural killer cells. They participate in the destruction of germ invaders. • Monocytes and macrophages: Are the first to attack germs or foreign invaders by engulfing and devouring them

Immune System

Large-scale social, economic, political and cultural forces influence the life course of masses of people Actions and policies of governmental organizations and ● non-governmentalorganizations Cultures and organized religions Wars Historical legacies (e.g. slavery, exploitation) Corporations and banks (e.g., globalization, exploitation) Unpredictable, large-scale environmental events, ● including natural disasters Examples The experience of African-Americans is conditioned by a legacy of historical slavery and racial discrimination The experience of women is conditioned by a background of past and current misogyny, abuse and discrimination The experience of disabled people is conditioned by discrimination and disadvantage The experience of war veterans, and of their families, is conditioned by their background of trauma, death, violence and post-war social and economic conditions

Macro-social Influences on Stress

Dramatic growth and development during the first 2 years of life coordinated by the endocrine (hormone) system • Early Childhood (2-6 years) • Marked by physical activity • Nutrition plays a key role in physical growth • Touch • Interaction with parents • Middle childhood (7 years to adolescence) • Healthiest period and cognitive development • Adolescence (12 to 17 years) • May be a turbulent period • Puberty: secondary sexual characteristics • Adulthood (18 to 64 years) • Fat distribution • Hair loss • Older adults (65 and above) • Menopause

Major Periods of Development

Neurotransmitters: • Chemicals that regulate nervous system functioning • Catecholamines: • Epinephrine and norepinephrine • Promote sympathetic nervous system activity • Released during stress

Neurotransmission

Psychological disorder triggered by exposure to an extreme traumatic stressor • Associated with combat and catastrophic environmental events • Recognized as an independent disorder during the Vietnam War • Psychological symptoms include haunting memories and nightmares, mental distress, flashbacks Diagnosis includes: • Prerequisite traumatic event • Three subsets of symptom types (e.g, flashbacks) • A duration of symptoms beyond one month after the associated event • Significant decrease in functioning (Helsley, 2008) • PTSD may occur even if the event is not experienced directly (Marshall, et al., 2007) • Physiological symptoms include increased cortisol, epinephrine, norepinephrine, testosterone and thyroxin over time • Frequent occurrence (comorbidity) of substance abuse problems, depression, anxiety disorder • People who feel a lack of social support, women who experience harassment or sexual assault, and those with lower intelligence may be especially susceptible

PTSD

Prenatal period (the period before the baby is born) • Gestation: time in womb • Preterm births: delivery prior to 37 weeks • Embryo: 2 weeks post fertilization • Fetus: after 9 weeks of gestation • Teratogens: substances which cause developmental abnormalities • Miscarriage: The release of the fetus before it is ready to survive on its own (spontaneous abortion) • Labor and delivery • Social support is beneficial for coping with both a miscarriage and labor and delivery

Pregnancy and Birth

Another general nonspecific response to stress: No matter what the stressor, the body reacts in the same way • General Adaptation Syndrome • Alarm: Faced with a stressor • Resistance: Coping with a stressor • Exhaustion: Break down of the body due to prolonged exposure to a stressor 3 phases: Stage 1: alarm (mobilize coping resources) stressors occurs, ability to withstand stress close to below normal Stage 2: Resistance (continue coping with stressor) ability to withstand stress is above normal) Stage 3: exhaustion (resources depleted) ability to withstand stressor goes down

Selye's General Adaptation Syndrome

• Maintain over time for emotional health 1. you 2. mother, romantic partner, mother, father, sibling, bff 3. colleague, friend

The Social Convoy

Tangible assistance • Provision of material support • Services, financial assistance, or goods • Informational support • Providing support through knowledge sharing • Emotional/Esteem support • Reassuring someone that they are important and cared for • Invisible support • Helping someone without them being aware of it

Types of SS

specialized curanderos male or curenderas female parteras as midwives soarers work with muscles and sprains yerberso are herbalists

curanderos/curanderas

Acupuncture, originally practiced only in China, has become increasingly popular throughout Western industrialized nations. • It has proved most successful in treating pain, although practitioners contend that it rejuvenates the body. • Typically involves inserting thin acupuncture needles superficially or as deep as 1 or more inches, depending on the particular site and the practitioner's style of treatment • Which of the approximately 2000 acupuncture points are selected, along with the angle and depth of the needle insertion varies with the symptom • Needles sometimes twirled, heated or electrically stimulated to maximize their effect • Acupuncturists often also incorporate herbal medicine and dietary recommendations in their treatment regimen Acupuncture and Pain • More than 100 randomized controlled clinical trials and several meta-analyses provide mixed results • Some patients receive some relief from: • Osteoarthritis • Back pain • Migraine & tension headaches • Menstrual pain • Tennis elbow • Postoperative dental pain Percutaneous Electrical Nerve Stimulation (PENS) • Relatively new form of acupuncture • Uses acupuncture-like needles to stimulate peripheral sensory nerves to assist in the management of pain • Found effective in management of postoperative gynecologic pain, migraine headache pain, and leg and foot pain from diabetes Acupuncture and Substance Abuse • Excluding 12-step programs, acupuncture is most widely used CAM method for treatment of substance abuse • Goal of acupuncture treatment • Reducing withdrawal symptoms, keeping abusers in programs and continuing abstinence from drug use • Mixed evidence • Some promise in treating pain, addiction and depression but overall effectiveness controversial How Well Does Acupuncture Work? • Most heavily researched CAM technique • Thousands of studies, most uncontrolled (pre/post treatment, using sample sizes that were too small, double-blind controls problematic) • Lack of standardization of acupuncture sites • Sham acupuncture often works (counter-irritation, placebo effect) FMRI: Acupuncture modulates neural activity in brain regions that are involved not only in somatosensory processing, but also in affective and cognitive processing. Acupuncture Safety Issues • Generally considered safe • Serious adverse effects are rare • Acupuncture patients may abandon conventional therapy and not receive a needed biomedical diagnosis or intervention • 35 states have established clinical practice standards for acupuncturists

Acupuncture

People performing stressful tasks become psychologically distressed and show physiological arousal • Identifies individuals most vulnerable to stress • Shows that stress responses can be reduced with the presence of a partner or a stranger

Acute Stress Paradigm

health beliefs reflect cultural roots in african healing, medicine of the civil war (south), european medical and anatomical folklore, west indies voodoo, and christianity strong connection with nature and herbs, inyangas are herbalists if betwitchment or personal/family crisis is suspected the sangoma is called (spiritual diviner healer)

African american beliefs

a wide range of traditional medical systems continues to flourish in africa, mixture of herbal and physical remedies intertwined with various religious belief systems systems that attribute sickness to ill will, to malevolent spirits, sorcery, witchcraft and diabolical or divine intervention still pervade the tribal communities of africa, the amazon basin, and pacific two dimensions are paramount of understanding african health beliefs: spiritual influences and communal orientation

African beliefs

Some critics argue that the development of general theories of stress is not a viable scientific objective. • Do bereavement, living in noisy environments, and poor role definition in the workplace have enough in common to lead to a broad general theory? • Stress may be an umbrella term that has been applied to so many different phenomena that it's no longer a useful construct Stress as a medical 'explain-all' • Stress may be used to explain the otherwise inexplicable, whether psychological or physical symptoms, or actual illness. • Why did your heart attack occur? If the you don't smoke, exercise, are normal weight, have normal blood pressure, and no family history of heart disease, the convenient answer is stress • Circular logic (have heart attack, must be stressed, so stress caused heart attack) "Stress" in everyday life • Stress can be a device for legitimizing behavior that is the result of anxiety, neurosis or personal inadequacy. • You can't shirk responsibilities because your too worried, not sleeping well or just not able to coping with the their demands, but if you got a doctor's or counsellor's note you're given leeway. • Where is the line?

Against General Theories of Stress

Ancient texts explain causes symptoms, physiology, prognosis, therapy, pharmacy as well as ethics Both the cosmos and each human being consists of a female component Prakrti which forms the body, and male Purusa which form soul. Purusa is constant, Prakrti is subject to change

Ayurveda Beliefs

Diagnosis made through inspection of the patient Yoga, purification, surgery drugs, diets, minerals, massage, color/gem therapy, homeopathy, acupressure, music, aromatherapy, meditation

Ayurveda Treatments

Health is a symbiotic and balanced relationship between nature (universe) and the supernatural world 5 elements can nourish, heal or poison (ether, air, fire, water earth) Elements can be combined to form: vata dosha (ether and air) nerves, circulation, respiration, elimination pitta dosha (fire and water) metabolisms of organs and cells kapha dosha (water and earth) growth and protection Body is defined in terms of flow of three doshas through channels srotas Sickness occurs when a channel is blocked and the flow is diverted into another channel Dosha ambulances associated with symptoms and constitution

Ayurveda and Health

Ayurveda has been in existence for 5,000 years and is practiced by billons based on hindu philosophy System is extensive in India, 70% of the population of India and hundreds of people throughout world use Ayurveda is the root for many common medical practices: eating garlic, yoga and using supplements

Ayurveda: Traditional Indian Medicine

Biofeedback • Biofeedback — system that provides audible or visible feedback on an involuntary physiological state • May be more effective with children than with adults • Few well-controlled clinical trials of patients with confirmed medical conditions • Even when effective, the reasons are not clear, raising the possibility that relaxation, an enhanced sense of control, or a placebo effect may be operating • Patients with lower back pain or migraine and tension headaches typically report less pain over time even without any form of treatment

Biofeedback

Model accounts for biology or physiology underlying health Psychology or the thoughts, feelings, and behaviors underlying health Society or the influence of culture on health Macrolevel and microlevel processes continually interact to influence health and illness

Biopsychosocial Approach

Broad range of determinants of health: Biology of physiology underlying health Psychology or the thoughts, feelings, and behaviors underlying health Society or the influence of culture on health

Biopsychosocial Model of Health

how do your psychological processes impact your biology? how does social environment impact biology? how does biology impact psychological processes? how does social environment impact psychological processes? how does biology impact social environment? how does psychological processes impact social environment?

Biopsychosocial Model of health

Herzlich (1973): health is an attribute of the individual - a state of harmony or balance. Illness was attributed to outside forces in our society or way of life Engel (1980) proposed that health and illness can be organized in a hierarchy from the biosphere and society down through the individual's level of experience and behavior to the cellular and subatomic level All levels interact and need to be considered if we are to understand health and illness World Health Org expanded definition of health as a state of complete physical, mental, and social well-being, not there mere absence of disease or infirmity Widened the scope of health care

Biopsychosocial model health

Biological influences: greater regulatory control, hardy personality Social influences: experiencing helpful social support, interacting with pets, disclosing emotional experiences articulately to family or friends or in writing Psychological influences: using active coping mechanisms, developing an optimistic explanatory style, being grateful, maintaining an optimistic explanatory style, establishing a feeling of personal control, exercising, relaxation techniques, cognitive therapy techniques contribute to coping with and managing stress effectively

Biopsyhosocial Coping Model

Diverse group of therapies, products, and medical treatments • Represents a vast and mostly unevaluated aspect of health care • National Center for Complementary and Integrative Health (NCCIH) - Created to evaluate the usefulness and safety of CAM (formerly NCCAM)

CAM

Prior to the advent of research, trial and error probably spurred the growth of CAM • Insufficient evidence from RCTs to support efficacy • Can't be evaluated as a whole • People believe CAM's work irrespective of research • the use of CAM can promote feelings of control, empowerment and agency Major Limitations of CAM • Lack of information on their effectiveness • Natural products are not regulated • Natural products may carry risk of adverse reactions and interactions with other OTC drugs • People may use CAM and not more effective traditional treatments • CAM are not usually covered under insurance, so may be expensive Integration • Integrative Medicine - mixture of both conventional medicine and CAMs • "Best of both worlds" ? • "In the end, no single approach to health care has all the answers; the search for the best solution to a medical condition often requires a willingness to look beyond one remedy or system of treatment."

CAM valid?

• A stressor triggers SNS activation, which results in increased • Circulation • Respiration • Metabolism Physiological Activation in Model • Activation of the Sympatho-adreno-medullary (SAM) System • The body's initial, rapid-acting response to stress • Involves the release of catecholamines from the adrenal • Epinephrine (adrenaline) and norepinephrine (noradrenaline) prepares the body and mind for fight or flight

Cannon's Fight or Flight Theory

Self-control predicts physical arousal • Physiological markers can be used to assess coping ability • Vascular responses • Threat appraisals produce blood pressure increase • Challenge appraisals produce heart rate increase • Vagal Tone is an internal biological process referring to the activity of the vagus nerve in the medulla oblongata to regulate homeostasis

Cardiovascular Reactivity

1. Direct Physiological effects -> elevated lipids, blood pressure, decreased immunity, increased hormonal activity 2. Health behavior changes -> increased smoking and alcohol use, decreased nutrition, sleep, increased drug use, poor diet, little exercise

Causal Pathways Stress

Humans are similar 99.8% of genes shared, sleep, eat and drink but we are different in the amount of sleep, food, drink Culture can influence our differences

Caveats:

In a world of rapid change and interpenetration of cultural groups and belief systems and an increasingly globalised society, health psychologists need to recognize the complexity and diversity of dynamic and interlocking systems rather than assume that our health belief systems are fixed

Changing cultures and health

Biology determines our life span. However, our biology is impacted by psychology and society.

Chapter 3: Essential Physiology Biological Development

General Definition • Negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes aimed at altering the stressful event or accommodating to its effects • Stressors: Events that cause stress Response vs. Stimulus Approaches to Stress • Response approaches attempt to identify characteristic physiological responses to stress, usually involving the cardiovascular or immune systems • Stimulus approaches focus on levels of stress associated with different life events and day-to-day difficulties Physiological Response Focused Approaches to Stress • Walter Cannon's Fight or Flight Theory (1914) • Hans Selye's General Adaptation Syndrome (1956)

Chapter 4 Stress

a. activating autonomic nervous system fibers that descend from the brain to immune tissue b. triggering the secretion of hormones hat bind to white blood cells and alter their functining c. inducing immunosuppressive coping behaviors, = poor diet and substance abuse Acute stress increases WBC count • Chronic stress leads to a under activated or over- activated immune response, both of which cause health problems

Chapter 5: Immuno -suppression Model of Stress and Illness Relationship

Chiropractic medicine: Complementary and alternative medicine approach to healing that is concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system. • Performing adjustments on the spine and joints to correct misalignments • Developed in the late 1800s • Believed to prevent and cure illness • Groups • Straight chiropractors: traditionalists who continue to believe that misalignments cause pain and manipulation is best form of treatment; wide range of ailments, from asthma to lower back pain to impotence • Mixers: combine traditional manipulations along with a broad range of other CAM therapies, including massage, physical therapy and nutritional therapy; limited range of conditions, especially acute low back pain, headaches and neck pain Does Chiropractic Work? • Enormous popularity, especially for back pain • 1974: congress permits Medicare payment • Chiropractic is licensed in all 50 states • Critics charge that chiropractic is useless because misaligned vertebra are common, harmless and usually clear up on their own • Retrospective and prospective evidence supports efficacy of chiropractic in treating low back pain • only small benefits for back and neck pain

Chiropractic Medicine

• Teaches people new, more adaptive ways of thinking and acting • Based on the assumption that thoughts intervene between events and our emotional reactions • Stress inoculation training: three-stage process that helps build "immunity" to stressful events CBSM has proven effective in helping people cope with hypertension, depression associated with chronic illness and in reducing HPA axis hormones Stage 1 reconceptualization -> stage 2 skills acquisition -> stage 3 follow through

Cognitive behavioral stress management (CBSM)

• Stress management program • Identifying stressors • Monitoring stress • Identifying stress antecedents • Avoiding negative self-talk • Completing take-home assignments • Acquiring skills • Setting new goals • Engaging in positive self-talk and self-instruction • Time management and planning • Identifying stress carriers and confronting them

Combat Stress Now

Different measures of health: the number of health-increasing behaviors practiced (exercise) psychological well-being (depression) the number of health-decreasing behaviors (smoking, alc) Physiological outcomes (cholesterol immunity, blood pressure, heart rate) Measurement reflects the biopsychosocial model

Common Rubrics for Health

• Alternative health care systems tend to be disparaged and marginalized by advocates of biomedicine. • Based on a positivist, reductionist perspective, practitioners of biomedicine believe that medical science is independent of any patient's psychological search for meaning, understanding and control. • In spite of this resistance from orthodoxy, complementary and alternative medicine (CAM) is gaining popularity and respectability in Western health care

Complementary and Alternative Medicine

Direct physiological effects such as suppression of the immune system • Direct cognitive effects such as distraction, loss of motivation, and memory loss • Direct behavioral effects such as changes in appetite, sleep, use of illicit substances, and diet • Secondary effects by exacerbating illnesses or delaying recovery

Consequences of Chronic Stress

• SES • Time • Money • Education • Employment • Standard of Living • Positive life events • Few additional stressors External Resources: Social Support • Information from others that one is • Loved and cared for • Esteemed and valued • Part of a network of communication and mutual obligations • Helps reduce stress, cope better, and live positively

Coping and external resources

Teaches people how to: • Assess stressful events • Disaggregate the stressors into specific tasks • Encourages people to maintain their social support • Phases of stress management • Learning and identifying stressors • Acquiring and practicing skills for coping with stress • Practicing the techniques

Coping effectiveness training

• Reducing or eliminating stressors • Tolerating or adjusting to negative events or realities • Maintaining a positive self-image • Maintaining emotional equilibrium • Continuing satisfying relationships with others • Enhancing recovery when ill • Keeping low physiological, neuroendocrine, and immune reactivity

Coping outcomes

Engagement vs. Disengagement coping • Behavioral Compensation (engagement) • When individuals expect to be discriminated against compensate by changing behaviors to disconfirm stereotype • Acquire set of skills to achieve desired outcomes • Added burden to have successful social interactions • e.g., use humor to increase chances of being liked • Severity of Prejudice influences degree of compensation and likelihood for its success Psychological disengagement • Detach self-esteem from outcomes in particular domain • Fear poor performance, de-emphasize importance of success • Disidentification: devaluing domain and removing self relevance • Discounting feedback as disengagement (attributional ambiguity) • BUT, theoretically result of systematic injustice • Black students likely to disengage in academic/intellectual domains

Coping w discrimination

• Assigns a limited role to psychological factors • Not all stressors produce the same endocrinological responses • Continued activation accumulates the most damage to physiological systems • Fails to address the debilitating effects of stress

Criticisms of General Adaptation Syndrome

Western: health is the state where disease is absent; biomedical approach Traditional Chinese Medicine: health is a balance of yin and yang (opposites) Ayurveda (India): health is the harmony of enzymes, tissues, and excretory function Mexican Americans: both biological and spiritual causes for disease Native Americans: balance between human beings and the spiritual world

Cross-Cultural Definitions of Health

• Australia reports very high use of CAM (68%) and this may be due to its integration with traditional medicine • European-Americans are more likely to use CAM than African Americans or Hispanic Americans • Chinese Americans use of CAM relates to how strongly they identify with their Asian heritage • Women tend to use CAMs more often than men • Well-educated and upper income people tend to use CAMs the most Other predictors • Acceptance of the underlying values of CAM • Those who have strong beliefs in science are less likely to use CAMs • Health status • Poor health is a predictor of CAM usage

Cultural differences in CAM usage

Culture impacts whether the individual needs social support and how much social support • Most significant differences exist between genders and social support • Females give and receive more support • Females experience more benefits from social support • However, there are differences between women in different cultures in what support they desire and receive • Familialism in Hispanic/Latinx women

Cultural variables in SS

Sudden nocturnal deaths among male hmong refugees from SE Asia after the VN war, occurred in the first few hours of sleep, autopsies released no specific cause of death Reasons: genetic susceptibility victims overwhelmed by cultural differences, language barriers, difficulties finding satisfactory jobs Immediate trigger provided by family arguments, violent tv, frightening dreams

Culture and case history of nightmare deaths

A mexican american folk art practiced at home in conjunction with western medicine Relies on the patient's faith and belief system combined with the use of herbs, fruits, eggs, and oils as healing tools based on christian beliefs, along with the belief that god can heal directly or through a person who has a gift from god to be a healer

Curanderismo and Spirtualism

two primary causes: natural: germs and other factors supernatural: evil spirit, witch, sorcerer, devil lack of balance/harmony between the natural and supernatural can cause illness OR the person's energy field is weakened or disrupted by any cause

Curanderismo sources of illness

Type 1: Insulin dependent (10% of diabetics) • Insulin producing cells are destroyed • Seen at a younger age • Treated with insulin injections • Type 2: Insulin levels are close to normal, but the receptor cells do not response to insulin Cultural Focus on Diabetes • Percentage per Population of Ethnic Group (NDIC, 2011) • Native Americans: 16.1% • Asian Americans: 8.4% • African Americans: 12.6% • Hispanic Americans: 11.8% • Non-Hispanic Whites: 7%

Diabetes Millitus

Supplements and natural products to improve health - supplement diet with various vitamins, minerals, herbs • Diets to improve health - follow a certain diet to gain health benefits; vegetarian, macrobiotic, Atkins, etc.

Diets, supplements, natural products

Whole medical systems • Health care systems that evolved independently of Western biomedicine, include traditional Chinese medicine, ayurveda and homeopathy • Mind and body medicine • Meditation, yoga, acupuncture, deep-breathing exercises, guided imagery, hypnosis, progressive relaxation, qi gong and tai chi. • Natural products • Botanicals, vitamins, minerals and other "natural" products • Manipulative and body-based practices • Spinal manipulation, massage therapy • Other CAM practices • Movement therapies, traditional healers, manipulation of various energy fields (e.g., putative energy fields)

Domains of Complementary and Alternative Medicine

Reactivity: Degree of change that occurs in autonomic, neuroendocrine, and/or immune responses as a result of stress • Allostatic load: Physiological costs of chronic exposure to the physiological changes from repeated or chronic stress • Allostasis: The ability to achieve stability through change • High load from prolonged exposure to stress hormones renders the body unable to turn off the stress response

Duration and Impact of Stress

• Good marriage • Familial support • Support from the community • Matching support to the stressor • Matching hypothesis: Support that meets the needs of a stressful event is the most effective support Emotional support is best provided by someone close to the individual • Social support is effective when the person from whom one is seeking support is perceived to be responsive to one's needs

EFF kinds of Support

• Lowers the likelihood of illness • Speeds up recovery • Reduces the risk of mortality • Encourages individuals to use health services and stick to their medical regimens

Effect of SS on illness

More effects of Long • Suppression of cellular immune function • Increased blood pressure and heart rate • Development of atherosclerosis • Psychiatric disorders • Problems with verbal functioning and concentration • Sleep disruption

Effects of long term stress

• Extreme Regulatory Control • Repressive coping — emotion-focused style in which we inhibit emotional responses, especially in social situations, so we can view ourselves as imperturbable • James Pennebaker • Expressive Writing Interventions • Emotional suppression triggers the fight-or-flight response • Emotional disclosure is associated with a variety of positive health benefits

Emotional Disclosure

Biomedicine was based upon a positivist epistemology that supposedly gave it access to an outside reality Positivism - science based upon direct observation, measurement and experimentation Distinction between superstition and reason Individualism in Western society health and illness became more closely entwined with knowledge of the individual physical body By mid-nineteenth century, medicine focused on the interior of the human body (pathophysiology)

Enlightenment Beliefs

Background stressors: • Noise can affect learning in children and be a source of stress • Crowding can increase physiological arousal, increase illness and aggression • Natural disaster stressors: Earthquakes, floods, hurricanes, etc. • Techno-Political stressors: Nuclear reactor accidents, war, terrorism, etc.

Environmental Stress

In one study, children living near airports found to have higher blood pressure and stress hormone levels • Cohen, Glass, & Singer (1973) — children who live in noisy homes have more reading problems than children who live in quieter homes • Because they are young, children are less able to tune out extraneous sounds, thus making chronic noise more disruptive Environmental Stress: Crowding • Calhoun (1970) • Rats living in a progressively crowded environment begin to engage in deviant behaviors • Population Density • A measure of crowding based on the total number of people living in an area of limited size • Crowding is not an inevitable consequence of density, it is a psychological state • Dorm Room Studies • Residents of traditional corridor rooms feel more crowded, less in control, more competitive and are more easily annoyed than those in suite-type room clusters

Environmental Stress: Noise

• Differences in Perspective and Focus • Biomedical researchers demand evidence from controlled clinical trials • CAM practitioners often claim that treatment variables cannot be studied independently Participant Selection and Outcome Measures • CAM evidence is often based on informal case studies • Anecdotal Evidence • Research evidence based on informal case histories, in which there is little or no objective documentation regarding a patient's diagnosis or the effectiveness of a treatment • Many CAM studies also rely on self-report and single- outcome measures Possible Causes of Improvement in a • Treatment is effective • Patient was misdiagnosed • The illness improved on its own over time • Spontaneous remission • Cyclical conditions (arthritis) • Placeboeffect • Placebo and nocebo

Evidence regarding CAM

Two or more different conditions are created to which people are assigned randomly and their reactions are measured Quasi-experimental designs: using naturally occurring groups to determine causality Randomized clinical trials: conducted to evaluate treatments or interventions and their effectiveness over time Evidence-based medicine: medical interventions go through rigorous testing and evaluation of their benefits before they become the standard of care

Experiments

• Explanatory Style • A person's propensity to attribute outcomes to positive causes or negative causes • Pessimism • Attributions that are global, stable and internal • Tendency to ruminate • Passive disengagment • Associated with anger, hostility, depression, smoking, alcohol and drug abuse; linked to early mortality • Optimism - Promotes active and persistent coping efforts • Broaden and Build Theory • Positivity increased physical, cognitive, and social resources • Help in effective coping • Optimism • Shorter hospital stays, faster recoveries, longer and healthier lives • Promotes healthier lifestyles • May also help sustain immune functioning

Explanatory Style

• Lowers psychological and physiological indicators of stress • Aids in effective coping • Helps organize thoughts and find meaning • Helps to focus attention on positive aspects • Provides an opportunity to clarify emotions • Affirms one's personal values

Expressive writing therapy

Sigmund Freud, specific unconscious conflicts produce physical disturbances symbolizing repressed psychological conflicts Symptoms: 'glove anthesis' (sudden loss of speech, hearing, sight), tremors, muscular paralysis, eating disorders Give rise to psychosomatic medicine

Freud and Conversion Hysteria

• Glucocorticoid-receptor (GCR) resistance model: chronic stress interferes with body's ability to regulate the inflammatory response • Glucocorticord hormones are anti-inflammatory signals that suppress proinflammatory cytokines • Inflammation can increase disease susceptibility and severity

GCR Resistance model of stress and illness relationship

Glucocorticoid-receptor (GCR) resistance model: chronic stress interferes with body's ability to regulate the inflammatory response • Glucocorticord hormones are anti-inflammatory signals that suppress proinflammatory cytokines • Inflammation can increase disease susceptibility and severity Empirical Studies of Stress and Illness • Experimental investigations and prospective studies • Stress and illness tracked in large samples of initially • Objective biologically verified measures of illness • Coronary heart disease (CHD), cancer, and infectious disease studied Stress and Coronary Disease (CHD) • Mix of positive and negative findings. • Macleod et al. (2002) reported a 21 year follow-up study of 2623 initially healthy Scottish men in which self- reported stress was found to be strongly associated with subsequent angina but not with other types of CHD. Stress-angina relationship probably results from a tendency of participants reporting greater stress to also report more symptoms. Occupational Stress and CHD • Several studies of workers in European countries with follow up periods from 5 to 10 years found an association between assessments of job strain and subsequent CHD • Reed et al. (1989) found no association in an 18 year follow up of 8006 Hawaiian men of Japanese ancestry • Eaker et al. (2004) found no association in a 10 year follow up of 1711 men and 1328 women in the USA Stress and CHD: Two 2012 meta analyses - • Richardson et al. aggregated 118,696 participants • Found that those with high perceived stress were 27% more likely than those with low perceived stress to be diagnosed with or die as a result of CHD at least 6 months later. • Kivimaki et al. pooled results from 13 European studies comparing risk of heart attack for 197,473 participants in high stress vs low stress jobs • Those reporting high job strain at a 23% increased level of heart attack risk • Prevention of workplace stress might decrease disease incidence, although to a much smaller extent than tackling standard risk factors, such as smoking

GCR resistance model of stress and illness relationship

• Physiological Differences • Men: stronger catecholamine reactivity to stressors • May reflect tendency of men to be more hostile than women • Women: stronger glucocorticoid response • May help explain gender differences in coronary disease Strategies • Men: emphasize problem-focused coping? • Women: emphasize emotion-focused coping? • Socialization Hypothesis • Girls and boys are socialized in different ways, creating life-long behavioral differences • Role-Constraint Hypothesis • When stressors are the same, gender is irrelevant Results of Gulf War study • Mixed support for both hypotheses • Gender differences greatest during war...in the other direction! (after war high use problem solving, and low use emotion coping) • Socialization hypothesis based on traditional gender stereotypes, which are disappearing

Gender differences in coping strategies

• Diathesis-stress model — an individual's susceptibility to stress and illness is determined by two interacting factors: • Predisposing Factors (in the person) • genetic vulnerability • acquired behavioral or personality traits • Precipitating Factors (from the environment) • traumatic experiences

Gene-Environment Interactions

• Genetics and Health • Genetic studies • Twins research help identify characteristics produced genetically vs. environmentally • Genetic disorders • Genetic contributions to obesity and alcoholism • Genetics and Health Psychology • Genetic counseling

Genetics

Has beneficial effects on mental and physical health • Enhancing social support • Prevents a lot of ailments and problems • Forms of beneficial social support systems • Networking/Internet-based systems • Family-based systems • Community-based systems

Giving Social Support

American Psychological Association: goals are Understanding the etiology of health promotion and maintenance Prevention, diagnosis, treatment and rehabilitation of physical and mental illness Improving the health care system

Goals of Health Psychology

• Hypothalamus releases corticotrophin-releasing hormone (CRH) • Stimulates secretion of adrenocorticotropic hormone (ACTH) • Stimulates the release of glucocorticoids • Repeated activation of the HPA axis will compromise its functioning

HPA Axis

Cluster of stress-buffering traits: categories of commitment, challenges, control • sense of having a strong purpose in life • see stressful situations as opportunities • personal control & self-efficacy. • Linked to lower levels of anxiety and adaptive coping styles; adjustment to cancer, cardiovascular disease, diabetes and many other health problems

Hardiness

• Suppression of cellular immune function • Increased blood pressure and heart rate • Development of atherosclerosis • Psychiatric disorders • Problems with verbal functioning and concentration • Sleep disruption • Shortened Telomeres

Health effects of long-term stress

Hippocrates and Galen: 4 humors Humoral theory of illness - Diseases resulted when the humors or circulating fluids of the body were out of balance Personality types associated with the humors: blood -passionate temperament black bile -sadness yellow bile -angry disposition phlegm -laid-back approach to life Disease in middle ages: God's punishment

Historical Perspectives on Health Greek Age

Disease during prehistory and ancient times thought to arise when evil spirits entered the body Body and mind intertwined Trephination (drilling holes in skull) one form of treatment to get rid of the spirits

Historical Perspectives on Health Prehistory

The Renaissance until Today Rene Descartes: separation of mind and body Technical bases of medicine discovered (focus on human anatomy) Diagnosis became dependent on laboratory findings and looked to bodily factors (organic and cellular pathology) Biomedical model of health predominates

Historical Perspectives on Health Renaissance

• Ancient Times: Stressors were physical in nature and acute or short term (e.g., predators or attacks from other tribes) • Today, stressors are more long term or chronic (e.g., relationships or illness like heart disease or cancer) • Both acute and chronic stressors can lead to a variety of poor health outcomes

Humans Evolved for Acute Stress

Starting in 5th century BC Greece: Hipporcrates' Humoral theory: four bodily fluids or humors including yellow and black bile, phlegm, and blood; basis of Graeco-Arabic medical system known as Galenic medicine Galen: medicine in the Roman empire Balance of humors is equated with health, ill health a consequence of natural processes, not a result of divine intervention, responsibility on individuals to look after themselves (four temperaments: choleric, sanguine, melancholic, phlegmatic)

Humoral Theory

Longer immigrants in new country, the worse their health • aka Healthy Migrant Effect • Individuals and generations Explaining the Paradox? • Recent immigrants need to be young and healthy to make journey • Eat better and don't smoke (cultural difference) • If they become ill, might return home to receive treatment • Over Time • Exposure to less healthy diets • Jobs become more sedentary • Loss of cultural heritage Acculturation • Berry's Model: combination of retaining old culture and adopting new culture • Assimilation-give up cultural identity and become absorbed in host culture • Separation-maintain cultural identity and avoid involvement in host culture • Integration-maintain cultural identity and become participant in new culture • Marginalization-no identification or participation in either culture • Integration/Biculturalism associated with best outcomes • Perhaps limited perspective • Multidimensional Approach: Heritage can be maintained in practice, value, and identification • Blending varies by dimension • Chicano identification (shared identity of Mexican- Americans) • Individualism risk factor, collectivism protective • Approach could provide more info on paradox • Acculturation interacts with context of reception • Discrimination, lack of access, etc. • Poor fit causes acculturative stress

Immigrant Paradox

Body's resistance to injury from invading organisms • Develops naturally or artificially • Nonspecific immune mechanisms and specific immune mechanisms • Phagocytosis: primary method of removing microorganisms in the blood and tissue fluids. Types of Immunity • Humoral immunity: • Mediated by B lymphocytes • Cell-mediated immunity: • Involving T lymphocytes (helper and cytotoxic) Lymphatic System's role in immunity: • Drainage system of the body • Spleen, tonsils, thymus gland are important organs Acquired Immunity • 5 Characteristics of Acquired Immunity • Specificity: Body responds to specific antigens previously encountered • Diversity: Different immune cells recognize different antigens • Memory: Each lymphocyte (memory T cells) remembers the same antigen if it returns, and attacks faster and with higher intensity • Self-Limitation: After antigen is destroyed, other responding cells will be turned off or suppressed • Self-Nonself-Discrimination: Will not attack personal body cells Nonspecific or Natural Immunity • Histamine: A chemical that instigates the inflammatory response • Examples of histamine action: • It causes the swelling that occurs at a cut, so the increased blood flow allows immune cells to stream to the cut area • Allergies Immune System Disorders • Disorders related to the Immune System: • AIDS • Progressive impairment of immunity • Cancer • Depends heavily on immunocompromise • Diseases of the Immune System • Infectious disorders: • Elephantiasis, splenomegaly, tonsillitis, mononucleosis, lymphoma • Autoimmunity (genetic susceptibility triggered by infection) Cell-Mediated • Cytoxic T-lymphocytes attack antigens that have altered self- cells • Humoral • B-Lymphocytes produce antibodies to fight freely circulating antigens • Acquired • previous exposure leaves specialized lymphocytes • Natural or Nonspecific • Histamine response of inflammation (more blood)

Immunity

a. activating autonomic nervous system fibers that descend from the brain to immune tissue b. triggering the secretion of hormones hat bind to white blood cells and alter their functining c. inducing immunosuppressive coping behaviors, = poor diet and substance abuse

Immunosuppression model of stress and illness relationships

Anticipating stress - Anticipation is as stressful as the actual event • Aftereffects of stress: Persist long after the stressful event itself is no longer present • Shortened attention span • Poor performance on tasks • Ongoing psychological distress • Physiological arousal Stress over time • Chronic strain: Develops when a stressful event becomes a permanent or chronic part of the environment • Depends on: • Type of stressor • Subjective experience of stress • Indicator of stress

Impact of Acute Stress

• Racially related stress affect immune systems (disease susceptibility) • Workplace and college negative interracial interactions: headaches and chronic fatigue • Often leads to emotional coping with unhealthy behaviors (e.g., smoking) • Frustration and Anger • Avoidance Coping-ailing to express leads to high blood pressure and sleep

Impact of perceived discrimination

Leonardo da Vinci and Andreas Vesalius: human anatomy William Harvey: discussed the circulation of the blood and functioning of the heart Antonious Van Leeuwenhoek: Microscopy and the study of blood, saliva, cells Louis Pasteur: study of viruses and bacteria (germ theory) Wilhelm Roentgen: discovered x-rays Technological advancement (pharmacology, surgery, MRI, CAT)

Important Contributions to Western Biomedicine

Decreases in cell-mediated immunity The inability to shut off cortisol in response to stress Lowered heart rate variability Elevated epinephrine levels a high was it to hip ratio(abdominal fat) hippocampal volume (decorare with repeated stimulation of HPA) problems with memory high plasma fibrinogen elevated blood pressure

Indicators of Allostatic Load

• Invasion of microbes and their growth in the body • Four means of infection • Direct transmission • Indirect transmission • Biological transmission • Mechanical transmission • The course of infection • Incubation period • Period of nonspecific symptoms • Acute phase (disease is at its height) • Fatality or a period of decline during which invading organisms are expelled

Infection

Influenced Osteopathy • Osteopathy - Form of medical practice that provides all the benefits of conventional allopathic medicine, including prescription drugs and surgery, and emphasizes the structure and function of the human body • Draws on the body's ability to heal itself • Osteopath seeks to facilitate healing using manual and manipulative therapy

Influenced osteopathy

Confucianism: human suffering (including disease) is traditionally explained as the result of destiny (ming) Buddhism: good deeds and charitable donations are promoted. Heavenly retribution is expected for those who commit wrongs. Concept of pao: reciprocity and retribution, in mutual relationships reciprocity is expected. When this does not occur some form of retribution will take place

Influential Philosophies

Integrative Medicine • Multidisciplinary approach to medicine that involves traditional biomedical interventions, as well as complementary and alternative medical practices that have been proven both safe and effective Many of the same trends that led to the emergence of health psychology led to increasing interest in CAM • Costly, impersonal nature of biomedicine • Adverse effects of treatment • Profit-driven nature of health care • More activist, consumer-oriented view of the patient role

Integrative Medicine

Individual Differences related to health and coping • Type A coronary-prone behavior pattern • Positivity/Negativity • Explanatory Style • Mastery/Locus of Control • Regulatory Control • Cardiovascular Reactivity • Hardiness/Resilience

Internal Coping Resources

• Individual Differences related to health and coping • Type A coronary-prone behavior pattern • Positivity/Negativity • Explanatory Style • Mastery/Locus of Control • Regulatory Control • Cardiovascular Reactivity • Hardiness/Resilience

Internal Resources

A transactional model — the experience of stress depends as much on how an event is appraised as it does on the event itself • Primary appraisal — determination of an event's meaning • Secondary appraisal — evaluation of one's ability to meet the demands of a challenging event • Cognitive reappraisal — process by which events are constantly reevaluated • Primary appraisals: We decide whether an event is: • Harmful: Will you loose something significant? • Threatening: Will it be very demanding and put you at risk for harm? • Challenging: We believe we can grow from dealing with the event. Event -> primary appraisal (harm, threat, challenge) -> secondary appraisal (are my resources sufficient) -> yes no/low stress or no high stress Factors Influencing Our Appraisals • Duration: Short term vs. long term events • Negative or Positive Valence: Threatening events vs. positive events (e.g., marriage) • Control: Knowing you can control a situation • Predictability: Being aware when a stressor is anticipated • Ambiguous: Not having details about or not understanding an event • Culture: Affects how a stressor is perceived

Lazarus' Cognitive Appraisal Model

Stressor -> hypothalamus activates pituitary -> pituitary activates adrenal cortex -> adrenal cortex releases corticosteroids cortisol

Main Physiological Pathway in General Adaptation System

Stress and Coping: examination of how biopsychosocial determinants of stress and how we cope Health behaviors: examination of exercise, smoking and diet Issues in health care: examination of chronic and terminal illness and doctor-patient interactions

Main areas in Health Psychology

• Social Readjustment Rating Scale (SRRS) — attempt to quantify life events in terms of life change units • First systematic effort to link stress and illness • Faulted for subjectivity and failing to consider individual differences Drawbacks of the SRRS • Some items on the life event list are vague • Individual differences are not considered • Does not assess whether stressful events have been successfully resolved • Time between stress and illness do not correlate Daily Stress • Hassles and Uplifts Focus • Daily hassles: Minor stressful events that lead to • Psychological distress • Adverse physiological changes • Physical symptoms • Use of health care services • Minor positive events (uplifts) counteract the impact of hassles Hassles and Uplifts • Daily Hassles Examples • Concern about weight, health, appearance, too much to do •DailyUplifts Examples • Relating well with friends, completing a task, getting enough sleep • Hassles have proven to be a better predictor of health problems than major life events or the frequency of daily uplifts Other Stress Scales • Life Experiences Survey: Events experienced AND their effects (distress) • Chronic Burden Scale • Perceived Stress Scale: How do you feel?

Major Life Events

Humans progress through major, identifiable stages of development • Each stage is marked by its own problems, rituals, expectations, and varies by culture • Two main categories of developmental theories • Social development • Cognitive development

Major Theories of Human Development

Massage • Reflexology • Chiropractic

Manipulative and body-based practices

Massage manipulates soft tissue to produce health benefits • Dates back thousands of years • Many different types of massage and some of which originated from other medical systems, such as TCM • Reduces stress and is believed to boost immune functioning and flush out toxins • Reduce lactic acid buildup and metabolic byproducts • Most frequently used to control stress and pain

Massage

• Ways of Coping (WCC) Aldwin, Folkman, Schaefer, Coyne & Lazarus, 1980 • 8 Subscales: Confrontive, Distancing, Self-Controlling, Seeking Social Support, Accepting Responsibility, Escape Avoidance, Planful Problem Solving, Positive Reappraisal • COPE (Carver, Sheier & Weintraub, 1989) • 13 Subscales: Active, Planning, Suppression of Competitive Act., Restraint, Support (instrumental), Support (emotional), Positive Reinterpretation and Growth, Acceptance, Turning to Religion, Focus and Venting of Emotions, Denial, Behavioral Disengagement, Mental Disengagement

Measuring Copig

• The coping responses and factors between the stressor and the outcome are called mediators • Mediators: The intervening process (variable) through which an independent variable affects the dependent variable • Stress may influence your health behaviors (sleep, eat) and the changes in health behaviors impact health Mediation • The relationship between stress and poor health outcomes is mediated by negative health behaviors Mediators: drink more alcohol or eat poorly -> poor health Moderators versus Mediators • In MOST cases, mediators can also be moderators and vice versa • However, cultural variables (age, ethnicity, race) cannot be mediators because they cannot be changed; culture is a key moderator of coping

Mediator Variables

Catholic asceticism promoted scorn for the body; acts such as fasting and physical suffering led to spirituality Protestant Reformation led to belief the body had been given to humans by God, so care for the body is a Christian duty Illness a sign of weakness and neglect honor god by abstaining from excesses (in sex and diet) Religious interpretations began to decline with the growth of medical science Though increasing acceptance of a naturalistic view of disease, the moral basis of health continues to underlie much of contemporary health belief

Medieval Christian Ideas

• Distressed by financial strain and work stress • Combining employment and marriage is protective for men's health • Stressful interpersonal events at work can increase conflicts with children • Employed, single fathers are more vulnerable to psychological distress

Men and Multiple Roles

Tools of neuroscience: functional magnetic resonance imaging (fMRI), permits glimpses into the brain, has helped to improve the knowledge of the autonomic, neuroendocrine, immune systems Mobile and wireless technologies: ecological momentary interventions, ambulatory blood pressure monitoring devices Meta-analysis: combines results from different studies to identify how strong the evidence is for particular research findings

Methodological Tools

• Basic premise: cognitive, emotional and spiritual factors can have profound effects on health • Acupuncture • Hypnosis • Relaxation • Meditation • Movement Therapies (Yoga, Qi Gong)

Mind-body therapies

Normative and non-normative events stressful • Identity development and school socialization (normative) harder for stigmatized (e.g., disclosing sexual orientation) • Acculturation (non-normative) creates stress in immigrants • Indirect causes of stress • Stigmatized groups have harder lives: lower SES hurts achievement, more family stressors like divorce, CYCLE OF STRESS Discrimination • Racism contributes to poor mental and physical health among migrants, ethnic minority groups and indigenous peoples. • Everyday experiences of discrimination are related to stress that could potentially lead to chronic illnesses (Gee et al., 2007; Williams et al., 1997). • Perceived discrimination is linked with physical ill health: cardiovascular disease, hypertension, respiratory conditions, obesity and diabetes (Cuffee et al., 2012; Nadimpalli and Hutchinson, 2012; Dolezsar et al., 2014). • DeLilly and Flaskerud (2012) claim relationship arises from negative feelings of low self-worth and subordination occupanied by depression or anger, hostility and aggression. Socio-economic status • Impoverished families experience more pollution, substandard housing, crime, low-paying work, limited education, lack of access to health insurance and health care • Greater incidence of health-compromising behaviors • Stein & Nyamathi (1999) — low SES takes greater toll -economic Status on women than men • Children from low-SES homes experience more divorce, punitive parenting, frequent school transfers • SES is inversely related to stress levels among most groups • Pitt County study: SES is positively related to stress (and mortality) in African-American men • More experience with and awareness of direct discrimination because of interracial contact • Precarious achievement • Pay gap

Minority Status Stress

• Direct effects hypothesis: Social support is generally beneficial during non-stressful as well as stressful times • May enhance the body's physical responses to challenging situations • Better immune functioning • Encourages healthier lifestyles • Better relationships with doctors, nurses, etc. Buffering hypothesis: Physical and mental health benefits of social support are chiefly evident during periods of high stress • May mitigate stress indirectly through the use of more effective coping strategies

Moderation of the Impact of Stress on Health

Any variable that people differ on (e.g., income, age, social support) can be a moderator • Moderator: a variable that changes the magnitude and/or direction of the relationship between two other variables (e.g., an independent variable and a dependent variable) • Being high or low on some factor often moderates (increases or decreases/buffers) how we react to stress Moderation • Stress predicts poor health outcomes, but that relationship is moderated by social support Person has a lot of social support -> more healthy some SS -> less healthy little to no SS -> less healthy

Moderator Variables

Complementary and Alternative Medicine Moving Forward • Major paradigm shifts in medicine and health care in the U.S. • Passive-dependent patient activist health consumers • Conventional medicine complementary relationship with CAM • Evolving Health Care Policy • Recently, the WHO launched a strategy on Traditional Medicine (2014-2023) to support the development of policies and action plans to strengthen the role of CAM to improve health, well-being and people- centred health care; and to promote quality and safety of CAM through regulation and better training and skills development of practitioners. The strategy aims to build a knowledge base around CAM, regulate products, therapies and practitioners, and integrate CAM into national health care systems.

Moving forward

sickness is the result of imbalances, maintain social and spiritual harmony and balance four different levels: internal, social, natural, and spiritual

NA sources of illness

coexistence of western and traditional medicine shamans or tribal elders coordinate the ability to communicate with spirits and connect the patient's life with their illness per tribal beliefs. varies by nation or tribes focus on rituals and traditions including: sweat lodge, medicine wheel, sacred hoop, singing

NA treatments

Naturopathic Medicine • System that aims to provide holistic health care by drawing from several traditional healing systems, including homeopathy, herbal remedies and traditional Chinese medicine Popularized in "Back-to-nature", Hygienic, and Holistic Medical Movements • Basic Principles • Help nature heal • Do no harm • Find underlying cause • Treat whole person • Encourage prevention • Recognize wellness • Act as teacher

Naturopathic Medicine

• Marked by anxiety, depression, and hostility • Related to: • Poor health • All-cause mortality • Higher levels of stress indicators • Associated with poor health habits • Do not respond well to treatments • Can create an illusion of poor health

Negative Affectivity

Disorders of the Nervous System: • Epilepsy • Cerebral palsy • Parkinson's disease • Multiple sclerosis • Huntington's disease • Polio • Paraplegia, quadriplegia • Dementia

Nervous System Disorders

After 2 months in law school, optimistic students showed a 13% increase in the blood level of CD4 cells (T-helper) in the bloodstream and a 42% rise in natural killer (NK) cell cytotoxicity

Optimism and Immune Function

Each culture has a unique understanding of human being's creation, purpose, and life Prehistoric concepts of our bodies and health were related to magic and spirits Human body was first systematically studied as early as 5,000 years ago with the Chinese, Indian, Greek, and Egyptian cultures

Origins of World Medicine

• Self-esteem - Associated with lower levels of stress indicators • Conscientiousness • Self-confidence • Intelligence • Emotional stability (low neuroticism)

Other Internal Resources

Behavioral Medicine: a field dedicated to examining the non-biological influences on health Epidemiology: study of the frequency, distribution, and causes of infectious and noninfectious disease in population Morbidity: number of cases of a disease that exist at some given point in time Mortality: numbers of death due to particular causes

Other influential Fields

Contemporary and Alternative Medicine CAM: includes traditional cultural practices Neuroscience: how do placebos work? Why are many people felled by functional disorders that seem to have no underlying biological causes? Why is chronic pain so intractable to treatment?

Other influential fields

Unbelievable anecdotal evidence for the effect • "Mr. Wright" and Krebiozen: participant expectancy • The most simple, basic explanation for the popular appeal of CAM is the placebo effect. • The generous time, warm glow of personal attention and friendly conversation received by each individual patient • But, actually helps aid many effective treatments; we should levergage the power of the mind! Why Do Placebos Work? • Many Alternative Explanations • Decreased anxiety • Through classical conditioning • "Remembered wellness" • Placebos may tap a natural "inner pharmacy" of self-healing substances • Any medical procedure can have a placebo effect • Harsh critics contend that CAM is entirely placebo-based Placebo Analgesia • Visible injections of placebos were significantly more effective in reducing injections • The knowledge of the placebo produced analgesia. • Injections that blocked endorphin production (naloxone) disrupted placebo induced analgesia • Injections that enhanced the activity of endorphins (proglumide) strengthened placebo-induced analgesia Provider Behavior and Placebo Effects • Effectiveness of a placebo varies depending on: • How a provider treats the patient • How much the provider seems to believe in the treatment • Effects are strengthened when the provider gives reassurance to the patient that the condition will improve Patient Characteristics and Placebo Effects • People who show stronger placebo effects are those who: • Have a high need for approval • Have low self-esteem and are persuadable • Are anxious Situational Determinants of Placebo Effects • Setting that is similar to medical formality • Shape, size, color, taste, and quantity of the placebo • Treatment regimens that seem medical and include precise instructions Social Norms and Placebo Effects • Placebo effect is facilitated by norms that surround treatment regimens • Expected way in which treatment will be enacted • Placebos are effective because people believe that drugs work Controlling for the placebo effect: the Double -Blind Experiment • One group of patients are given a drug/treatment to cure a disease or alleviate symptoms and another group is given a placebo • Measure of the treatment/drug's effectiveness - Difference between the effectiveness of the treatment/drug and the effectiveness of the placebo

Participant Expectancy and the Placebo effect

• Direct Effect Hypothesis • Changes to the cardiovascular systems leading to an increased risk of heart disease, including strokes and heart attacks • Changes to the immune system leading to increased susceptibility to infections, cancer and auto-immune diseases such as arthritis • Immunosuppression is part of the body's natural response to stress • HPA and SAM neuroendocrine response to stress may reduce the body's defenses • Indirect Effect Hypothesis • Stress may encourage maladaptive behaviors that disrupt cardiovascular and immune functioning • Changes in health behaviours known to influence disease susceptibility, such as smoking, diet, exercise and alcohol consumption

Pathways from Stress to Disease

• Personal Control • The belief that we make our own decisions and determine what we do or what others do to us • Self-efficacy (Albert Bandura) • Uncontrollable stress yields learned helplessness • Personal control is associated adaptive, problem- focused coping and healthier lifestyle behavior • Low perceived control in racial/ethnic minorities, older adults, and low SES • Control-enhancing interventions: Use information, relaxation, and cognitive-behavioral techniques to reduce anxiety, improve coping, and promote recovery

Personal Control

• Vitalism • Concept of a general life force, popular in some varieties of CAM • Homeopathy • Interprets disease and illness as caused by disturbances in a vital life force • Treatment - Use diluted preparations • Traditional Chinese Medicine • Ayurveda Alternative practices not part of a larger medical system aimed at treatment of or relief from illness • Chiropractic treatment • Types of Massage • Diets, supplements, and natural products

Philosophies behind CAM

• Hypothalamic-Pituitary-Adrenal (HPA) Axis: The body's delayed response to stress • Acts like the SAM activation but affects the adrenal cortex which produces of corticosteriods • Cortisol: Generates energy to deal with a stressor by converting glycogen in glucose • Hypercortisolism - Cushing's Disease • Hypocortisolism - Addison's Disease

Physiological Activation in Selye's Model

• Stress: The upsetting of homeostasis • Homeostasis: The ideal level of bodily functions • Stressor: Anything that disrupts the body's homeostatic balance • Stress response: What is done to re-establish the homeostatic balance

Physiological Def of Stress

• Physiological Measures of SNS activation • Blood Pressure-systolic and diastolic • Heart Rate • Galvanic skin response • Blood and urine levels of hormones like cortisol, epinephrine, norepinephrine • Acute Stress Paradigm • Viral Exposure

Physiological Measures

• Promotes better mental and physical health • Linked with lower levels of stress indicators • Triggers better immune responses • Improves coping

Positivity

Reduces illness to low-level processes such as disordered cells and chemical imbalances Fails to recognize social and psychological processes as powerful influences over bodily estates --assumes a mind-body dualism Emphasizes illness over health rather tan focusing on behaviors that promote health Model cannot address many puzzles that face practitioners: if 6 people are exposed to flu virus, why only 3 develop flu?

Problems with Biomedical Model

People vary greatly in how they react to stress- potentially no "typical" stress response exists • Typically physiological understandings—neglect social and emotional responses

Problems with Response Approaches

Looks forward in time to see how groups of people change, relationship between two variables changes over time Conducted to understand the risk factors that relate to health conditions Longitudinal research: same people are observed at multiple points in time, can be cross-sectional, sequential, retrospective and prospective designs

Prospective Research

Subfield of health psychology that emphasizes the interaction of psychological (psycho), neuroendocrine (neuro) and immunological processes in stress and illness

Psychoneuro-immunology

Psychological factors causal Somatic Symptom Disorders (controversial) Pain, neurologic problems, gastrointestinal complaints, sexual dysfunction Disorders include illness anxiety, body dysmorphia, pain disorders Criticisms Bad methodology Few illness explained Conflict or personality type is not sufficient to produce illness

Psychosomatic Medicine

The study of the mind's influence on health Specific illnesses are produced by people's internal conflicts Perpetuated in the work of Franz Alexander and Helen Flanders Dunbar(linked patterns of personality to specific illnesses)

Psychosomatic Medicine

lifeforce or energy qi moves within the body in the same pattern as in nature qi flows through the 12 meridians/channels, associated with organs

Qi

Qi Gong - practice of TCM; series of exercises or movements intended to help body's energy and restore balance • Tai Chi - a category of Qi Gong; involves slow, gentle movements • Tai chi and qi gong have been shown to relieve pain and improve quality of life for people with fibromyalgia • Both have also been shown to help reduce stress • Tai chi has been shown to be helpful in reducing tension headaches

Qi Gong and Tai Chi

• State of relaxation which can help reduce stress and discomfort; originated in the late 1700s • Controversy over whether hypnosis is an altered state of consciousness, social interaction, or generalized trait • Effects of hypnosis may just be composite effects of: • Relaxation • Reinterpretation • Distraction • Drugs • Hypnosis • Prehypnotic stage of rapport-building • Suggestions and imagery to induce relaxation and the focused attention of the hypnotic trance • Treatment stage, with suggestions/imagery to reduce pain • Consolidation with posthypnotic suggestions to be carried out after the hypnosis session has ended • Posthypnotic stage where patient is alerted, given additional instructions (self-hypnosis) and released Does Hypnosis Work? • Physiologically resembles other forms of deep relaxation • Focused awareness (e.g., high-stress situations) • Suggestibility predicts if hypnotizable • Fantasy prone • Responsive to authority figures

RHypnosis

• Reflexology involves the application of pressure and massage to specific reflex areas in the body • Reflex areas are usually on the feet, but can be applied on the hands and ears. • Based on the belief that certain areas on the hands and feet correspond to other parts of the body • Massaging these can help to dissolve blockages of accumulated waste to encourage the free flow of vital energy and to restore the balance between yin and yang. • Reflexology is currently being applied to relieve symptoms of various chronic health conditions such as asthma, back pain, irritable bowel disorder, headaches, insomnia, and stress

Reflexology

• Regulatory Control • The ways in which people modulate their thinking, emotions and behavior over time and across changing circumstances (self-regulation) • Good regulatory control • Calmer, able to delay gratification, control emotions, more problem-focused coping • Too loose (under-controlled) • Impulsive, unable to delay gratification, aggressive, venting

Regulatory Control

• Dealing with parents in childhood and adolescence • Adolescence: The transition from the importance of the family to peers puts stress on whole family • Family stress can come from within the family or from surrounding environment • Unhealthy interpersonal relationships • Spousal or child abuse • Caregiving

Relationship Stress

Progressive Relaxation Training • Mindfulness-Based Meditation • originated from Buddhism • sit quietly and focus on thoughts and sensations without judgment • Transcendental Meditation • originated in India • Focused consciousness, on the sound "om" or mantra • Guided Imagery Guided Imagery • Meditative procedure that has been used to control discomfort related to illness and treatment • Patient is instructed to conjure up a picture that he or she holds in mind during the experience of discomfort • Induces relaxation Benefits of Meditation • Mediation and guided imagery have been shown to be very effective in managing chronic pain • Effective treatment for certain functional disorders • anxiety, stress-related problems, and relapse into depression How Might Relaxation and Meditation Promote Health? • May alter a person's emotional response to pain and other symptoms (teach sufferers to reinterpret pain) • May bolster the immune system • Relaxation training has been shown to increase natural killer (NK) cell activity (Kiecolt-Glaser et al, 1985) and boost serotonin levels (Alexander et al, 1989)

Relaxation and Meditation

Uses scientific method: assumptions, attitudes, and procedures that guide researchers in creating questions to investigate, in generating evidence and in drawing conclusions

Research in Health Psychology

• The ability of individuals to bounce back and adapt flexibly to stressful situations • Origins • Easy temperaments; high self-esteem; sense of personal control; well-developed academic, social and creative skills (social cognition) • Social support • Resilience promoting resources • Sense of coherence and purpose about life • Sense of humor and trust in others • Sense that life is worth living • Religious beliefs

Resilience

Researchmethodsoftenattempttodemonstratethatstress is associated with undesirable physiological changes which are likely to have disease consequences. • Stress management based on reducing these physiological effects, using techniques such as biofeedback, relaxation, breathing exercises, yoga and meditation

Response Approaches: Research and Application

Looks backwards in time in an attempt to reconstruct the conditions that led to a current situation, were critical in identifying the risk factors that led to the development of AIDS Epidemiological studies: examines trends in diseases (prevalence, incidence, relative and absolute risk)

Retrospective Designs

• Helps individuals feel better about themselves • Lowers physiological activity and distress • Undermines defensive reactions to health threats

Self-affirmation therapy

• Stress contagion effect: Stress from one domain can "spillover" into others (e.g., relationships to work) • Stress can also "crossover" from individual to individual

Spreading Stress

Quantify stress and relate to health outcomes • Demonstrate that higher levels of measured stress are predictive of subsequent physical illness. • Stress management based on making jobs and environments less stressful Problems with Stimulus Approaches • People vary greatly in how stressful they find different events and situations-no way to quantify the impact • Research linking life event stress and physical illness typically relies on retrospective methods • Problems of interpretation-people who have suffered recent illness more likely to recall recent stressful events • People with high levels of anxiety and depression are both more likely to self-report stress and more likely to self- report illness leading to a misleading correlation Interactional Approaches to Stress • Stress is assumed to occur whenever individuals experience an imbalance between the perceived demands of any life event or situation and their perceived ability to cope with these demands. • Richard Lazarus' Cognitive Appraisal Model (1966)

Stimulus Approaches: Research and Application

• Variety of psychological methods designed to reduce the impact of potentially stressful experiences Stress Management: Exercise • Significant benefits following exercise at 60 to 80 percent of VO2 max (aerobic capacity based on oxygen consumption) • Physiological Effects: • Enhanced blood flow to the brain • Lower blood pressure and resting heart rate • Reduced cardiovascular reactivity to stress • Fewer stress-related health problems • Psychological Effects • Enhanced sense of well-being • Decreased anxiety • Exercise offers time out, change of pace, boost to self- esteem (e.g., can improve appearance, strength) • Reduces depression by elevating low serotonin level — similar to effect of antidepressant drugs Stress Management: Relaxation • Relaxation based approaches • Relaxation • Guided imagery • Systematic desensitization • Progressive muscle relaxation • Mindfulness Meditation • Biofeedback • Hypnosis, Yoga, etc. Relaxation Therapies • Relaxation Training • Affects the physiological experience of stress by reducing arousal • Relaxation response — meditative state of slowed metabolism and lowered blood pressure Mindfulness Meditation • Teaches individuals to: • Have a higher awareness of the present • Focus on the present and accept it • Mindfulness-based stress reduction (MBSR): therapy that helps people to manage their reactions to stress and the resulting negative emotions

Stress Management

• Could stress be a factor in the onset and development of HIV/AIDS? • The rate at which the disease progresses varies considerably from person to person, stress could be explanatory • Rarely possible to know when an individual was first exposed to the HIV virus • Subsequent diagnosis and disease progression is associated with much further stress, lifestyle changes and the occurrence of other infections • Leserman (2008) found consistent evidence that stressful life events are associated with a range of indicators of disease progression, including mortality • Unclear if direct effects of stress on the immune system or changes in stress-related behaviour • Adherence to medication, substance use, sexual risk taking and lack of exercise all may cause more rapid disease progression Moderating variables • The effects of stress on illness may be reduced by a number of 'moderating variables' • High levels of social support have a buffering effect • Perhaps only those with low levels of support more likely to get ill as a result of stress • Personality variables may also act as a buffer against the effects of stress on illness • high level of measured 'hardiness' (Kobasa) and 'sense of coherence' (Antonovsky) • More on this next time

Stress and HIV/AIDS

• Studies of the subsequent occurrence of cancer following periods of stress have usually failed to find evidence of an association • No indication of a higher cancer rate among the bereaved or former prisoners of war, men who had suffered extreme forms of mental and physical hardship (Keehn, 1980) • Heikkila (2013): meta-analysis of studies of the relationship between reported job strain and cancer incidence. In 116,056 participants, no clear indication of a significant association Stress and Breast Cancer • Medical speculation about a possible link between stress and breast cancer goes back at least as far as 1893 • Reviews of research and meta-analyses by McGee (1999) and Duijts et al. (2003) found no association in large scale prospective studies. • Nielsen et al. (2005) reported an 18 year follow up of 6689 initially healthy Danish women and found surprisingly that those reporting higher stress levels were actually at reduced risk of breast cancer (but higher risk of CVD) Stress and Infectious • Studies of stress and the immune system have shown significant effects of some forms of stress • Immunosuppression evidence not strong enough to prove increased susceptibility to disease • Viral Challenge Studies • Intentionally exposing people to viruses and assessing whether they get ill and the intensity of illness • People experiencing more stress are more likely to get sick and mount a stronger immune response Viral challenge studies • Cohen and Miller (2001) exposed volunteers reporting varied levels of stress to one of five cold viruses under carefully controlled conditions. • Any subsequently occurring symptoms were tested biologically to determine whether the virus had developed into a cold. • For all five viruses, increased levels of perceived stress was associated with an increased likelihood of developing a cold. • In a similar study, researchers found that the longer the duration of reported stress (typically interpersonal and work problems), the greater the probability of catching a cold. • Acute stress did not appear to increase susceptibility.

Stress and cancer

• Cognitive-Behavioral Approaches: Focuses on a combination of behavioral (conditioning) and cognitive skills to deal with stress

Stress management CBT

Hardy managers who reported high levels of stress experienced significantly lower levels of illness than did those low in hardiness. Evaluating the Hardiness Hypothesis • Does hardiness ignore individual differences in the perceived severity of a given stressor? • Are hardy people healthier because they have greater personal resources? • On balance, studies support idea that some people handle stress more effectively because they view themselves as choosing to live challenging lives • Hardy people are more likely to engage in positive reappraisal of stressful events

Stress, Hardiness, and Illness

• Participants who perceived low levels of stress and high satisfaction with social contacts had significantly lower levels of PSA, a biological marker of prostate malignancy.

Stress, SS, PSA

• Low socioeconomic status • Exposure to violence • Living in poverty-stricken neighborhoods • Community level stressors • Parents' work and family stressors Affects academic achievement and leads to acting out in adolescence • Social and academic failure experiences at school increases a child's aversive behavior at home • Children who grow up in risky families • Have problems with emotion regulation and social skills • Have difficulty forming good social relationships • Can develop heightened sympathetic reactivity to stress, exaggerated cortisol responses, or chronic inflammation

Stressful experiences for children

• Coping styles: General predispositions to deal with stress • Approach coping • Avoidant coping • Coping strategies: The specific behavioral and psychological efforts used to minimize stressful events • Problem-focused • Emotion-focused Coping Style • Propensity to deal with stressful events in a particular way • Avoidant coping style: Coping by avoiding • Approach coping style: Coping by gathering information or directly taking action Problem focused and emotion Focused Coping Strategies • Problem-focused coping: Attempting to do something constructive about the stressful conditions • Emotion-focused coping: Regulates emotions experienced due to the stressful event • Escape-avoidance • Distancing • Positive reappraisal • Emotional-approach coping: Clarifying, focusing on, and working through the emotions in response to a stressor • Aids in adjusting to chronic conditions and medical conditions • Helps manage stress better • Proactive coping - Anticipating potential stressors and acting in advance

Structure of Coping

• Identify the most common stressors of everyday life • Provide evidence for the stress-illness relationship • Provide possibilities for intervention • Important as stress-related disorders lead to disability and social security payments to workers Reducing Stress at Work • Minimize physical work stressors • Minimize unpredictability and ambiguity • Involve workers in decisions that affect their work • Make jobs interesting • Help workers to develop meaningful social relationships at work • Reward workers for good work • Add workplace perks that enhance quality of life

Studies on Workplace Stress

symptoms and the patient's life characteristics are used to diagnose the pattern of disharmony treatment is focused on settling the imbalance through massage, acupuncture or acupressure and herbs to enhance the flow of Qi

TCM Diagnosis and treatment

• Type A • Friedman & Rosenmans term for competitive, hurried, hostile people who may be at increased risk for developing CVD • Type B • More relaxed people who are not pressured by time considerations and thus tend to be resistant to coronary disease Type A and Hostility • Carver & Glass (1978) • Type A students more likely to retaliate (instigation condition) than Type B students • Hostile People • Show a weak antagonistic response to sympathetic activity • Show larger and longer-lasting blood pressure responses

TYPE A personality

Most influential philosophy in TCM Taoism views the universe is a vast and indivisible entity and each being has a definite function within it Tao (origins of life and universe) is created by the opposing forces of Yin and Yang

Taoism

• In addition to fight or flight, people and animals respond to stress with: • Social affiliation • Nurturant behavior toward offspring • Oxytocin is released during stressful events • Acts as an impetus for affiliation • More common in Women • Evolutionarily Beneficial

Taylor's Tend-and-Befriend Model

Those two types of belief systems are not discrete but interact in a process of constant evolution Majority of people in any society organize meaning-making with indigenous belief systems; still connected in some form with expert belief systems Dominant expert health belief systems may encompass principles and guidelines that inform practitioners and specialists in systems of treatment for different illnesses

Technical vs. Traditional Systems

• Heart, blood vessels and blood • Transport system of the body • Arteries carry blood from heart to other organs and tissues • Veins return blood to the heart after the oxygen has been depleted Historical Perspective on the System • Prior to 550 B.C.: Pneuma is the vital spirit of life; blood is not recognized • 500-430 B.C.: The Greek Empedocles of Agrigentum, the heart is the center of the circulatory system, and is the seat of pneuma • 300 B.C.: Erasistratus still talked about pneuma, identified veins and arteries • 150 B.C.: Galen clarified functions of veins and arteries, indicated that heart was a heater for blood • 1628: William Harvey understood the heart as a pump • 1689: Marcello Malphighi discovered capillaries The Blood • Blood: • Adult body contains 5 liters • Consists of plasma and cells manufactured in bone marrow • Disorders related to • White cell production • Red cell production • Clotting • Blood pressure: • Force that blood exerts against the blood vessel walls • Hypertension is high blood pressure • Caused by age, obesity, diet, etc. Cardiovascular System Disorders • Disorders of the Cardiovascular System: • Artherosclerosis: • Narrowing of the arteries • Clinical manifestations: • Angina Pectoris: chest pain • Myocardial Infarction: heart attack • Ischemia: lack of blood flow • Congestive heart failure (CHF) • Arrhythmia • Rheumatic Fever: • Bacterial infection that can spread to the heart • May cause endocarditis, inflammation of the membrane that lines the cavities of the heart

The Cardiovascular System

Functions of the Digestive System: • Breaking down food • Metabolism • Absorption of food • Accumulation of food residue Chewing and salivary enzymes break down food in mouth • Gastric fluids digest proteins in stomach • Secretions from liver, gallbladder, and pancreas act on food in the 20 feet of small intestine • The large intestine, or colon, terminates in the rectum and anus Digestive System Disorders • Disorders of the Digestive System: • Gastroesophageal reflux disease • Gastroenteritis, diarrhea and dysentery • Peptic ulcer • Appendicitis • Hepatitis • Cancer

The Digestive System

• Complements nervous system in controlling bodily activities • Regulated by the hypothalamus and pituitary gland • Consists of ductless glands that produce hormones • Discovered in the 1900's Major Endocrine Glands and Associated Hormones • Pituitary gland: Oxytocin (social bonding) • Pineal: Melatonin (biological clocks) • Thyroid: Thyroxine (growth) • Parathyroid: Parathyroid hormone (blood calcium) • Thymus: Thymosins (immunity) • Pancreas: Insulin (blood glucose) • Adrenal: Cortisol (glucose metabolism) • Ovaries: Estrogen (sexual development in women) • Testes: Androgens (sexual development in men) Adrenal Glands • Small glands at top of each kidney composed of • Adrenal medulla and adrenal cortex • Medulla produces epinephrine and norepinephrine Endocrine System Disorders • Disorders involving the Endocrine System: • Diabetes: • Body cannot manufacture/properly use insulin • Type I: insulin-dependent diabetes • Type II: insufficient insulin or sensitivity to it

The Endocrine System

Base: age, sex, hereditary factors 1: Individual lifestyle factors 2: Social and community networks 3. Agriculture/food production, education, work environment, living and working conditions, unemployment, water and sanitation, health care services, housing 4. general socioeconomic, cultural and environmental conditions

The Health Determinants Onion

Amygdala: • Detection of threat • Hippocampus: • Emotional memories • Cingulate gyrus, Septum, areas of the Hypothalamus: • Emotional functioning

The Limbic System

• Central Nervous System: Brain and spinal chord; process and coordinate information that it receives from the peripheral nervous system. • Vertebrae brain: Comprised of three parts • Hindbrain (rhombencephalon): Medulla, pons, cerebellum • Midbrain (mesencephalon) • Forebrain (prosencephalon): Cerebral cortex

The Nervous System

Transmits information to entire body • Consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves • Has two main divisions: • Somatic nervous system—conscious control of skeletal muscles • Autonomic nervous system—unconscious control of muscles • Sympathetic and Parasympathetic

The Peripheral Nervous System

• Somatic Nervous System: Controls the skeletal muscles and is under voluntary control (e.g., movement) • Autonomic Nervous System: Coordinates muscles NOT under voluntary control and acts automatically (e.g., heart rate) • Sympathetic Nervous System (SNS): Speeds up bodily responses • Parasympathetic Nervous System (SNS): Slows down bodily responses

The Peripheral Nervous System

• Walter Cannon • Fight-or-flight reaction • Outpouring of epinephrine, cortisol and other hormones that prepare an organism to defend against a threat • Adaptive for our ancestors • May contribute to stress-related illnesses in modern times

The Physiology of Stress

• Consists of kidneys, ureters, urinary bladder and urethra • Regulates bodily fluids by removing surplus water, surplus electrolytes, and the waste products generated by the metabolism of food Renal System Disorders • Disorders of the Renal System: • Urinary tract infections: • If untreated, may lead to more serious infections • Acute glomerular nephritis: • Usually a secondary response to a strep infection • Tubular necrosis: • When cells in the tubules of the kidneys are destroyed, acute renal shut-down can occur • Kidney failure: • Treatments include: artificial kidney, transplant, kidney dialysis

The Renal System

Ovaries and Testes: • Women: • Two ovaries produce estrogen and progesterone • One ovary produces an ovum (egg) each month • If ovum isn't fertilized, it is flushed out of the system during menstruation • Men: • Pituitary controls production of testosterone by the testes • Testosterone brings about the production of sperm and secondary sex characteristics Reproduction • Fertilization and Gestation: • Sperm ejaculated into vagina during intercourse proceed upward through uterus into fallopian tubes • One sperm may fertilize ovum, which travels down a fallopian tube and embeds in uterine wall • Human gestation continues for nine months Reproductive System Disorder • Disorders of the Reproductive System: • sexually transmitted diseases • chronic pelvic inflammatory disease (PID) in women • cancer • disorders of the menstrual cycle • fertility problems

The Reproductive System

Respiration has 3 functions: To take in oxygen To excrete carbon dioxide To regulate the composition of the blood • Inspiration is active; expiration is passive This system is important because: • Poor health behaviors such as smoking or breathing toxic fumes wreak havoc on lungs • Lung capacity is a measure of cardiovascular fitness Respiratory System Disorders • Disorders of the Respiratory System: • Hay Fever • Asthma • Viral infections • Bacterial infections • Chronic Obstructive Pulmonary Disease • Pneumonia • Tuberculosis and Pleurisy • Lung Cancer Asthma Facts • Is a disease of the airways of the lungs • Symptoms include wheezing, breathlessness, and coughing and chest pain • Can be triggered by smoke, exercise, allergies, cold or hot temperatures, extreme emotional experience, some weather conditions (humidity, cold air), odors • Low association with mortality rates

The Respiratory System

Medical encounters have significant features: Communication issues, fear arousal, medical error Relationships between patient and practitioner determine use of services and treatment outcomes Patients respond to illness and treatments in different ways and interventions can be helpful: Information, preparation, relaxing, guided imagery, social support, counseling Health policy has many behavioral aspects: restrictions on smoking, drinking, food labelling

The importance of the biopsychosocial model

Process of diagnosis can benefit from understanding the interacting role of biological, psychological and social factors Many illnesses have behavioral causes (use of alcohol and tobacco , poor diet, lack of exercise) Psychological theories and methods are used to prevent or chance, unhealthful behaviors (smoking cessation, dietary changes)

The importance of the biopsychosocial model

Social support changes over the lifespan • Social Convoy Model: General levels of support will be constant or even increase • Socioemotional Selectivity Theory: People prune their social networks to maintain a desired emotional state

Theories of SS change

Theory: set of analytic statements that explain a set of phenomena Advantages: provide guidelines for how to do research and interventions, generate specific predictions that can be tested and modified, help tie together loose ends

Theory-based

To provide health treatment that is natural (1), holistic (2),and promotes wellness (3) • "Back-to-nature" backlash against modern technology, science, biomedicine (anti-vax) • Overspecialization and fragmentation of modern medicine • Biomedicine may fight illness but generally does not focus on producing an optimal state of vitality

Three ideals of CAM

Treats more people than any other form of medicine Holistic approach: the body is treated as a whole due to the connections within the body Macroscopic vs microscopic Critical elements of health are food choices, relationships, and emotional life

Traditional Chinese Medicine

Reticular formation to thalamus to hypothalamus to limbic system to cerebral cortex --> Route for information about a potential stressor Higher brain regions to reticular formation to target organs, muscles and glands controlled by sympathetic nervous system --> Body mobilized for defensive action

Two Neural Pathways of Brain-Body Communication under Stress

Conventional Medicine • Involves biomedically based medicine as practiced by holders of the MD (medical doctor) or DO (doctor of osteopathy) degrees and their allied health professionals • Evidence-Based Medicine • Promotes the collection, interpretation and integration of the best research-based evidence in making decisions about the care of individual patients Holistic Medicine • Considers not only physical health but also the emotional, spiritual, social, psychological well-being • Complementary and Alternative Medicine (CAM) • Involves use and practice of therapies or diagnostic techniques that fall outside conventional biomedicine

Types of Medicine

Ability of the parasympathetic nervous system to slow the heart rate back down • Related to less emotional arousal and constructive coping

Vagal Tone

Focused on allopathic medicine: treatments to cause the opposite effect of the disease; taught, practiced, and prescribed by many northern american/europeans Marked by reliance on technology and science for diagnosis and treatment Reductionism or the search for a single cause of illness Approaches outside of western biomedicine are called complementary or alternative medicine (CAM)

Western Biomedicine

According to WHO, health state of complete physical, mental, and social well-being. Varying lay definitions: Absence of disease Absence of injury or illness Bein able to do many physical exercises Being able to run fast Being happy Being spiritually satisfied

What is Health?

• Coping: The individual efforts made to manage distressing problems and emotions that affect the physical and psychological outcomes of stress and whatever we do to re-establish homeostasis • Coping process: The process of reacting to a stressor and resulting in either a favorable (health) or unfavorable (illness) outcome What Influences Coping? • Coping is dependent on the individual and the situation • Sociocultural and psychological differences can influence coping by... • changing the stress or coping experience (moderation) • producing a particular stress or coping experience (mediation)

What is coping?

• Appraisals of a stressor and coping strategies and their outcomes are impacted by personal resources • External Resources • Social Support (next time) • Culture and Environment • Internal Resources • Individual Differences • Personality Coping and External Resources • SES • Time • Money • Education • Employment • Standard of Living • Positive life events • Few additional stressors SES High SES • Money, time, less stress, and other resources • Low SES • Chronic Burdens • Less problem-focused coping • Possibly due to sense of hopelessness; only recourse is to manage emotional response • Women use more frequent avoidant coping strategies (passive behaviors, fantasizing, antisocial behaviors) Coping and Ethnicity • The relationships among SES, stress, coping and health behaviors varies with ethnicity • Pitt County study: SES is positively related to stress in African-American men • John Henryism • John Henry as folk hero—worked so hard that he died • Extreme active coping John • The John Henryism active coping (JHAC) hypothesis suggests that struggling to overcome life challenges predicts increased risk for cardiovascular disease for those with scarce coping resources Henryism • Scale • "When things don't go the way I want them to, that just makes me work even harder" • "I've always felt that I could make of my life pretty much what I wanted to make of it.

Who copes well?

People with better social skills receive more support • Angry and hostile people receive less support than agreeable people do • Angry people report more negative life events • Angry people make others feel more stress

Who receives and benefits from SS?

• People who are not successfully treated by traditional medicine • People who face delays in receiving medical care and cannot afford high costs of medical care

Who uses CAM?

Culture: a dynamic, stable, set of goals, beliefs, and attitudes shared by a group of people Includes: ethnicity, race, religion, age, family values, region, SES, biological sex Culture varies within groups

Why is culture important?

• Conflicting home and work responsibilities increase stress • Role Overload: problem associated with juggling multiple roles simultaneously • Working women with children have • Higher levels of cortisol • Higher cardiovascular reactivity • More home strain • Single women raising children on their own are most at risk for health problems Protective Effects of Multiple Roles • Combination of motherhood and employment • Is beneficial for health and well-being • Improves self-esteem • Improves feelings of self-efficacy, and life satisfaction • Best outcomes if... • Control and flexibility over one's work environment • Good income • Domestic help and adequate childcare • Supportive, helpful partner

Women and Multiple Roles

2012 poll indicates work is top stressor for North Americans • Almost everyone experiences work-related stress at some point • Work-related stress may be one of the most preventable health hazards Occupational stress • Symptoms include frustration, anger, resentment, low self-esteem, boredom, job dissatisfaction, loss of concentration, spontaneity, creativity, and emotional hyperactivity • Work Overload • People who feel they have to work too long and hard at too many tasks feel more stressed and have poorer health habits; experience more accidents and more health problems Causes Deprivational stress: The result of a job that does not keep a worker's interest • Assembly line hysteria: Physical symptoms (e.g., nausea, weakness, headaches and blurry vision) seen in workers with repetitive jobs • Ambiguity and role conflict • Role conflict: Occurs when a person receives conflicting information about work tasks or standards from different individuals • Lack of control over one's work life • Demand-control-support model: High demands and low control, combined with little social support at work • Inability to develop satisfying social relationships at work Outcomes • Higher rates of absenteeism • Job turnover • Tardiness • Job dissatisfaction • Sabotage • Poor performance on the job Burnout • Job-related state of physical and psychological exhaustion • Jobs that involve responsibility for other people appear to have higher levels of burnout (nurses, firefighters, air traffic controllers)

Work Stress

Active forces that illustrate the relationships between human beings and nature Wood, fire, earth, metal, water Each related to a season, emotion, organ etc.

Wu Xing: 5 phases/elements

Yin is the female, negative force that leads to darkness and emptiness. organs: solid, more vital (heart, liver, pancreas, kidney, lungs) Yang is the male, positive energy that produces light and fullness. organs: hollow, most health problems (gall bladder, intestines, bladder) A healthy person has a balanced amount of yin and yang Symptoms are related to excess of deficiencies in yin or yang

Yin and Yang

Breathing techniques, posture, strengthening exercises, and meditation • Used to treat: • Chronic pain, bronchitis, symptoms associated with menopause • Stress and the mental and physical ailments related to stress, including anxiety and depression • Cancer-related fatigue

Yoga

• Aromatherapy involves the use of essential oils from plant extracts for therapeutic purposes. • Ancient Egyptian, Chinese and Indian traditions • Diffusion in air, direct inhalation, topical application • Rene-Maurice Gattefosse (1881-1950), the father of modern aromatherapy, first discovered the healing properties of lavender by accident • Experiment on essential oils including thyme, lemon and clove; used on First World War soldiers as antiseptics • In recent years, aromatherapy is being used for stress and pain relief, headaches, digestive and menstrual problems. • As with other CAMs, systematic reviews on the efficacy of aromatherapy have produced inconclusive results

aromatherapy

Biofeedback • System that provides audible or visible feedback information regarding involuntary physiological states • Techniques • Attempt to control physiological responses, such as lowering heart rate • Electromyography (EMG) feedback • used to help people control low back pain and headaches by learning to decrease muscle tension • Thermal biofeedback Effectiveness • Beneficial in treatment of stress-related health problems • Still too few well-controlled clinical outcome trials • Mixed results from few studies • Small benefits for lower back pain • Lehrer and colleagues found that • Biofeedback can reduce autonomic arousal, anxiety and stress-related disorders in some people; does not convey advantage over other behavioral techniques • May be result of enhanced relaxation, placebo effects, spontaneous remission, or suggestion

biofeedback

"To be culturally competent doesn't mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept, that there are many ways of viewing the world." Culturally competent health care involves developing: 1. Culturally sensitive staff who are able to reflect about their own beliefs and practices and acknowledge diversity in the community. 2. Culturally appropriate materials, activities and systems that address linguistic, cultural and social barriers.

cultural competence

3 levels of treatment: material -household items and religious symbols spiritual -trance, out of body travel, medium mental- the power of the curandero biopsychosocial focus with spirituality and the community

curanderismo treatments

Substantial evidence that diet (foods or supplements) can have a major effect on risk factors for certain diseases • Higher fiber, low-fat, vegetarian (Pritikin Diet/Ornish diets) reduce risk • Increasingly accepted treatments for managing cardiovascular disease, lowering blood glucose levels in diabetics and reducing insulin needs

dietary medicine

Diseases that are strongly affected by lifestyle and environment are among those for which naturopathic treatment is most often reported to be effective • Allergies, fatigue, arthritis, asthma, headache, hypertension • Critics claim that unsuspecting consumers are flooded with unsupported claims and that herbs are not tested according to pharmaceutical standards

does naturopathy work?

Energy Healing - general idea that energy can heal the body • Biofield energy healing • Spiritual healing • Distant healing • Contact healing • Therapeutic touch • Reiki - developed in 1922 by Japanese Buddhist Mikao Usui; practitioners manipulate energy from the universe to the body of the recipient • Scientific evidence does not support efficacy

energy healing

Nutritional medicine: correct dietary deficiencies • Megadose therapy: trigger specific therapeutic effect • Linus Pauling and vitamin C • 10 to 15 times the recommended daily allowance • Dietary Medicine • Correcting food allergies/sensitivities • Trigger foods: sugar, wheat, dairy • Raw food theory/macrobiotics

food supplement therapy

Types of herbs: derived from the leaves, stems, roots, bark, flowers, fruits, seeds and sap of plants, herbs (also called botanicals ) can be prepared or marketed in different forms • Central role in Chinese medicine, ayurvedic medicine, Native American medicine, etc. • Forms: tonics, tinctures, decoctions, effectors • Evidence: animal and human trials were effective in treating arthritis, osteoarthritis, burns • Some mixed results for other uses • With the growth of the pharmaceutical industry, herbal medicine can now be produced and marketed on a massive scale

herbal medicine

• Premise counterintuitive • Diluting makes the effects stronger • Solution retains the "vital energy" of the substance • Popular in the UK, homeopathy has been used for a variety of health conditions—asthma, ear infections, hay fever, allergies, dermatitis, arthritis, high blood pressure, depression, stress and anxiety • Systematic reviews found inconclusive results and trials of poor quality

homeopathy

link between humans and natural world human fate is linked to trees, mountains, sky, and oceans (navajo idea of walking inboxed beauty) animals, plants/trees, bugs, rocks, and wind are all sacred if heathy or once one has experienced a ceremonial change process to correct the state of illness, their journey is in the natural order living the loving way, in right relationship to the elements of the four cardinal directions

native american health beliefs

exist 10,000 years in some ways similar to TCM and curanderismo heath is a sense of physical, emotional, and communal harmony four common practices: herbal remedies, ritual purification or purging, use of symbolic rituals and ceremonies, use of healers (medicine men/women/shaman)

native american medicine

• Some unregulated dietary supplements may contain hazardous substances • FDA warns against use of certain herbs/supplements by those taking prescription medications

safety concerns

Long-term and grinding • Contributes to psychological distress and physical illness

Chronic Stressful Conditions